Describe the nature of Mental Illness

Mental illness is a diagnosable illness that significantly interferes with an individual’s cognitive, emotional or social abilities. It is highly prevalent in Australian society with 20% or 3 mn people expected to experience a mental disorder between the ages of 16-85(AIHW 2012). There are numerous types of disorders that each differ in severity and in turn, have differing impacts on individual, families and society as a whole. These can be broken up into two broad categories of psychotic and non-psychotic illnesses.
Anxiety disorders, depression and schizophrenia are among the most common forms of mental illness. Information on an extensive range of mental illnesses including those mentioned can be viewed at the Mental Health Association NSW website linked below.
http://www.mentalhealth.asn.au/home/item/62.html .




Psychotic illnesses – result in an individual having the inability to distinguish between reality and fantasy during a psychotic episode. The most common forms of psychotic illnesses are bipolar and schizophrenia.
Signs and Symptoms of psychotic illnesses include;
  • Alterations in thoughts, such as false beliefs
  • Alterations in perceptions, including hallucinations and changes in sensory awareness
  • Alternations in emotions – displaying extreme emotions
  • Alterations in behaviour, for example, unusual reactions
http://www.openroad.net.au/access/dakit/psychiatric/pshandout4.htm



Schizophreniaencompasses a group of serious mental disorders where imagined and disordered thoughts are key features, often with problems of behaviour, mood and motivation, and a retreat from social life. (AIHW Report, 2012: Glossary.) Additional symptoms include:
  • hallucinations
  • delusions
  • disordered thinking
  • flat or inappropriate emotions
  • cognitive impairment
  • loss of motivation
  • withdrawal.
Mental Health Association NSW, Schizophrenia Fact Sheet, 2011: p1.

Non-psychotic illnesses – are those mental illnesses that exaggerate feelings and interfere with an individual’s ability to cope with everyday life, including the maintenance of relationships. Common types of non-psychotic illness include phobias, anxiety, depression, eating disorders and OCD.
Signs and symptoms of these include;
  • Increased moodiness
  • Irritability and sensitivity
  • Social withdrawal
  • Reckless behaviour
  • Insomnia
  • Loss of interest in everyday activities, such as food and physical activity
http://www.agedcareaustralia.gov.au/internet/agedcare/publishing.nsf/Content/What+is+mental+illness


Anxiety disorders are a group of mental disorders marked by excessive feelings of apprehension, worry, nervousness and stress. Examples include panic disorder, various phobias, generalised anxiety disorder, obsessive-compulsive disorder and post-traumatic stress disorder. (AIHW Report, 2012: Glossary.) Symptoms include:
  • fear
  • panic
  • irritability
  • excessively worrying
  • having difficulty relaxing, concentrating or sleeping
  • sweating
  • shortness of breath
  • headaches
  • nausea
  • muscle spasms
  • heart palpitations
(Mental Health Association NSW, Anxiety Fact Sheet, 2011: p1.)


Depressionis a mood disorder with prolonged feelings of being sad, hopeless, low and inadequate, with a loss of interest or pleasure in activities and often with suicidal thoughts or self-blame. (AIHW Report, 2012: Glossary.) Additional symptoms include:
  • eating or sleeping too much or too little
  • headaches
  • nausea
  • irritability
  • excessive crying
  • low levels of energy
  • feelings of guilt or worthlessness
  • difficulty concentrating, remembering or making decisions

(Mental Health Association NSW, Depression Fact Sheet, 2011: p1.)



Determine the extent of the problem by interpreting trends and statistics in Australia

  • In 2009–10, the Australian Government paid $755 million in benefits for Medicare Benefits Schedule (MBS) subsidised mental health related services, around 4.9% of all MBS subsidies. Subsidies for psychologist services made up $287 million of the expenditure. Around 9.7% of subsidies for prescription medication were spent on prescriptions for mental health conditions (equivalent to $35 per Australian) (AIHW, 2011d).
  • Around three-quarters (76%) of people who experience mental disorder during their lifetime will first develop a disorder before the age of 25 years.
  • Young women were more likely than young men to have had a mental disorder (30% compared with 23%).

http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/1301.0~2012~Main%20Features~Health%20status~229

  • Prevalence data from the ABS 2007 National Survey of Mental Health and Wellbeing confirm that many young people experience mental health disorders.
  • Estimated 1 in 4 young people aged 16-24 years (26%) had experienced a mental health disorder, which was found to be a higher proportion than any other age group, as it is evident that after the peak of the prevalence of mental illness in the 20 -29 age bracket, it consistently declines with age, as shown in the graph below.

mental graph 2.png
  • In 2007, females aged 16-24 years were more likely to have experienced a mental health disorder than males of the same age (30% and 23% respectively). The most commonly reported mental health disorders among 16-24 year olds were anxiety disorders (15%), substance use disorders (13%) and affective disorders (6%), with females tending to be more likely to experience anxiety disorders (18% compared to 11% for men) and affective disorders (7% compared with 5% for men). Conversely, substance use disorders were more common in men at 7% compared to women's 3%. As stated in the ABS, Yearbook Australia, 2012.
external image hoyp1_2_1_clip_image002.gif

  • The National Survey of Mental Health and Wellbeing in 2007 found that 7.3 mn Australians or 45% of the popn aged 16-85 will experience a common mood disorder such as depression, or substance use disorder, over their lifetime. While, each year on average 20% or 3mn of the popn in this age range will experience symptoms of a mental disorder. (DoHa 2009)
  • The mortality rate from mental illness has declined since its peak in mid to late 1990s and currently contributes to 0.5% of overall deaths or 686 deaths in 2009. The significant decline in the fatality of mental illness can be attributed to the fact that health is no longer perceived on a biomedical approach, it now focuses on holistic health, with both physical and mental well being. However, it still contributes significantly to burden of disease at 13% in 2010 (AIHW 2008 Report).
  • The declining mortality rate of mental illness is evident in the graph below;

mental graph 1.png

  • Comorbidity in relation to mental illness involves more than one mental disorder, or at least one mental disorder and one or more physical conditions. In 2007, 38% of people with a mental disorder had two or more mental disorders. With the most common combination being mood and anxiety disorders accounting for 39% of all comorbidity cases. The heavily debilitating effects of mental illness of an individual is shown as people with comorbidity were 10 times as likely to report higher levels of psychological distress than people with no mental disorder. (ABS, Yearbook Australia 2012)
    Picture2.png
    As evident in the graphs, anxiety disorders are most common of the represented disorders, in particular among males in their 40s to 50s. This is likely to be contributed to by the stresses of corporate work settings and high demands of employment as well as supporting a family.

Outline the risk factors and protective factors for Mental Illness

Simplistic diagram of risk and protective factors for children
Simple diagram of risk and protective factors for children
Simple diagram of risk and protective factors for children


Risk factors

Individual factors
  • Male gender - suicide rates are higher in males than females, across all age groups. They are highest in the 20s and 30s, then rise again in elderly people;
  • Psychological and emotional problems - for example, low self-esteem, being very introverted, social inadequacy, being impulsive, recklessness, hopelessness, anxiety, anger, aggression and violent behaviour;
  • Sexual Orientation - some studies suggest that young gay or lesbian people may have an increased risk of suicidal behaviour, possibly through being more likely to experience prejudice, homelessness, depression and substance use;
  • Physical health problems - for example, recent onset of serious illness, chronic or painful illness, functional limitations due to illness, injury or age;
  • Stressful life events - for example, recent loss of a significant person, relationship breakdown, disciplinary or legal crisis, interpersonal conflict.
Mental illness
  • Major depression - major depression carries a significant risk for suicidal behaviour and may be associated with low levels of certain neurotransmitters in the brain;
  • Other depressive illnesses - other depressive illnesses may also be associated with suicidal behaviour - for example, bipolar disorder has been shown to be a significant risk factor for completed suicide;
  • Substance use disorder - alcohol and other drugs exacerbate other mental illnesses and may decrease inhibitions and increase impulsive and risky behaviour;
  • Antisocial behaviour - there is some association between suicidal behaviour and antisocial behaviour, such as conduct disorder, oppositional defiant disorder and antisocial personality disorder;
  • History of psychiatric care - a previous history of mental illness which required psychiatric care increases the risk of suicidal behaviour;
  • Previous suicidal behaviour - a previous history of suicidal behaviour increases the risk of suicide or suicide attempt.
Family-related risk factors
  • Family breakdown - divorce or separation may leave family members feeling isolated and vulnerable and increase the risk of depression and suicidal behaviour;
  • Family conflict or poor communication - for example, marital discord, family conflict, domestic violence, extremely high or low parental expectations and control, parental mental illness such as depression or substance abuse;
  • Child abuse - the risk of suicidal behaviour may be increased when there is a history of child abuse, such as neglect, sexual abuse, physical abuse, emotional abuse, witnessing abuse or domestic violence;
  • Family history of suicidal behaviour - the risk of suicidal behaviour is higher in families of those who engage in suicidal behaviour and increases with closer genetic connections.
Social risk factors
  • Socio-economic disadvantage - social disadvantage and economic disadvantage may increase the risks of mental health problems and suicidal behaviour;
  • Indigenous communities - suicide rates are higher in Indigenous communities and particularly high among young Indigenous men;
  • Migrant populations - overall suicide rates for immigrants are similar to those among other Australians but there is variation among immigrant groups; females and people over the age of 65 are at higher risk;
  • School disengagement - mental health problems and the risk of suicidal behaviour may be higher among young people who are disengaged from school, which may be seen in non-participation, early school-leaving, truancy and suspension;
  • Unemployment - unemployment appears to increase the risk of suicidal behaviour, possibly through lack of social contact, loss of sense of identity, reduced activity and sense of purpose and lower income;
  • Isolation - for example, social isolation, being isolated by unemployment or homelessness, living in a remote place;
  • Rural Communities - some studies suggest that suicide risk may be higher in rural communities, perhaps due to isolation and social problems; in Australia the elevated risk seems to be most applicable to young men.
Environmental risk factors
  • Access - ready access to methods of ending one's own life may increase suicide rates, for example in countries with high gun ownership;
  • Exposure in peers or the media - people may be at higher risk if a friend, acquaintance or family member has shown suicidal behaviour - exposure in the media may increase risk if the story is sensational or provides detailed description of the method of self-harm.

Protective Factors

A number of factors have been identified which seem to reduce the probability of suicidal behaviour. In general, health and security and a sense of connection to others seem to be important in the prevention of suicide. The following protective factors have been suggested:
  • Connectedness - a sense of connection with family, school or the community;
  • Significant other - the presence of a caring adult to provide support for a young person, or the presence of a caring partner or family member for an adult;
  • Responsibility for children - for adults, having the responsibility for children or for family communication is protective;
  • Personal resilience - some personal attributes enhance resilience, such as problem solving skills and positive coping styles;
  • Spirituality and beliefs - protective factors may include a strong spiritual or religious faith, a sense of higher meaning or purpose in life, or a belief that suicide is wrong;
  • Economic security - economic security is protective, particularly in older people;
  • Good health - good physical and mental health is a protective factor;
  • Effective treatment - the early identification and effective treatment of mental health problems such as depression is important in protection from suicide;
  • Restricted access - lack of access to a means of suicide can help to reduce suicide risk, such as restricting the presence or accessibility of guns or certain medications.
Warning signs for suicide
While it is difficult to predict who will be at risk of suicide, there are some signs which may indicate that a person is thinking about ending their own life. Some of the possible warning signs for suicidal behaviour include:
  • A person has threatened to end their own life, either verbally or in some other way such as a letter or poem;
  • A person has made statements which suggest that they are thinking about suicide, e.g. Life isn't worth living, or Nobody would care if I wasn't around any more;
  • A person with problems has made a covert statement that might suggest they have come to a final decision, e.g. It's okay now, soon everything will be fine;
  • Sudden changes in behaviour and 'tying up loose ends', such as giving away prized possessions, writing farewell notes or making out a will;
  • Increased risk-taking behaviours such as heavy drinking or drug use, driving while intoxicated, dangerous behaviour such as hanging from moving trains or vehicles;
  • Signs of persistent and severe emotional problems, such as withdrawal, hopelessness, helplessness, guilt, poor self-worth, inability to function at home or school or work.
Sources
Beautrais, A. L. (2000). Risk factors for suicide and attempted suicide among young people. Australian and New Zealand Journal of Psychiatry 34, 420-436.
Commonwealth Department of Health and Aged Care (2000). Learnings about Suicide, in Life: Living is for Everyone - A framework for prevention of suicide and self-harm in Australia. Available online atwww.mentalhealth.gov.au
Conwell, Y., Duberstein, P.R. et al. (1996). Relationships of age and Axis I diagnoses in victims of completed suicide: a psychological autopsy study. American Journal of Psychiatry, 153, 1001-1008.
Nowers, M. (1997). Suicide and deliberate self-harm in the elderly. Current Opinion in Psychiatry, 10, 314-317.
Draper, B. (1995). Attempted suicide in old age. International Journal of Geriatric Psychiatry, 11, 577-587.

Risk Factors for Psychotic Illnesses
  • Genetic factors - the development of psychotic illnesses has hereditary links, as shown by the fact that parents with schizophrenia have a 10% chance of passing it on to their children.
  • Biochemical factors - abnormalities in the types and amount of neurotransmitters in the brain can result in the development of schizophrenia, while bipolar is caused by a chemical imbalance in the brain that can result in an episode of depression.
  • Environment - stressful experiences, such as the loss of a family member, are also seen as influencing this mental illness, however, it has not been discovered if the illness caused the stress, or the stress resulted in the illness
  • Seasons - it has been identified that experiencing a manic episode is more likely to occur in spring and early winter


Risk factors for non-psychotic illnesses

  • Genetic factors – increased chance of depression and anxiety if in family history, particularly if a close relative has developed the disease.
  • Biochemical imbalance –depression can be caused by chemical imbalance in brain, with altered hormone levels acting as a trigger for the development of the disease. This puts females at a higher risk of depression and anxiety as after childbirth and throughout menopause the levels of oestrogen in the body alter dramatically.
  • Stress-environmental factors such as social and economic disadvantage or discrimination can cause an episode of depression.
  • Personality –specific personality traits can make an individual more susceptible to depression such as heavily introverted or dependent people.

Protective Factors

In addition to the above protective factors, factors that can reduce likelihood of mental illness include;
  • Medication –can help control both psychotic and non psychotic illnesses such as anti-depressants, which is the leading mental disorder most frequently managed by GPs in 2010/11 according to BEACH survey.
  • Strong cultural and spiritual beliefs –can allow for an individual to have a wider outlook on life, and believe in a higher being, resulting in having a purpose for life, thus reducing chances of mental illness.
  • Temperament – a resilient and easy temperament can reduce likelihood of developing a mental illness, through positive coping styles and problem solving skills.
  • Personality – an easy-going, optimistic personality is likely to prevent the onset of mental illness.
  • Here's a great website for risk and protective factors - http://www.responseability.org/site/index.cfm?display=134912

The importance of understanding the signs and symptoms of depression and the protective factors is shown in this advertisement by BeyondBlue a prominent organisation that raises awareness on the commonality of mental disorders.
http://www.youtube.com/watch?v=iGE4CAlsSfQ

Discuss any existing links between Mental Illness and sociocultural, socioeconomic and environmental determinants

Sociocultural determinants include:
  • More people willing to discuss the issue of mental illness due to the break down of stereotypes and stigmas.
  • Aboriginal communities where their risk of developing mental illnesses may remain undetected because Indigenous people often consult elders rather than a GP or mental health professional.
  • Family- genetic predispositions such as prevalence of mental illness in family members, and genetic mutations passed down from parents are non-modifiable factors that influence an individual’s likelihood to develop mental illness. Such as the fact that parents who have schizophrenia, have a 10% chance of passing it down to their children. While, family composition such as breakdown of family relationships or abusive parents can trigger the development of a mental illness such as bipolar or depression.
  • Exposure to bullying
  • Media –the media and organisations play an important role in raising awareness on the issue of mental illness, while reducing the stigma associated with these conditions, this is evident through the BeyondBlue organisation that promotes understanding of the common occurrence of depression and anxiety, as 20% of Australians have experienced a mood disorder in the past 12 months.
  • Changing family structure is also a factor. Family breakdown, ending in divorce reduces the strong relationship support offered by the family.

Socioeconomic determinants include:
  • Stressful circumstances linked to individual's poor financial status can be attributed to the fact they are socioeconomically disadvantaged.
    A lack of employment prospects. This can lead to increased stress levels among young people and the long term unemployed, which in turn can result in the development of mental illness or a manic episode.

Environmental determinants include:
  • Rural, young males, limited access to support services and less job opportunities.
  • Geographic location and access to health services- people living in remote areas have a restricted access to appropriate health facilities evident as the NT has the lowest service rate out of all states at 39.5 per 1000 population, (AIHW, Mental health services in brief, 2012 page 5) highlighting the lack of services available to those in remote areas.



Identify the population groups most at risk and examine reasons why the prevalence/incidence among this group is higher than that of general population.

Almost half of all Australians will experience mental illness at some time in their life. About one in five Australian adults will be affected by mental illness each year. With appropriate treatment and support, most people affected by mental illness will recover well.

45 per cent of Australian adults are affected by mental illness during their life time. The most common forms of mental illness are:
  • Depression – around 15 per cent of adults are affected by depression at some point in their life.
  • Anxiety disorders – around 26 per cent of adults are affected by anxiety disorders at some point in their life.
The remainder of people with mental illness are affected by substance use disorders, psychotic illnesses (for example, schizophrenia) and by other conditions.

Around three per cent of adults are severely affected by mental illness. The more severely disabling ‘low prevalence’ mental illnesses include:
  • Schizophrenia – this disorder affects approximately one per cent of Australians at some point in their life.
  • Bipolar disorder – this condition affects up to two per cent of Australians at some time during their life.
  • Other forms of psychosis – for example, drug-induced psychosis.
  • Some chronic forms of depression.

Those with family members with a history of mental illness have an incredibly high chance of also having it. Although a predisposition to schizophrenia and bipolar disorder can be inherited, this is only one of several factors that contribute to the development of the illness. It is likely that these mental disorders also involve a chemical imbalance and are triggered by:
  • Stressful life events
  • Drug misuse
  • Hormonal changes.

Population groups with a higher risk of developing a mental illness include;

  • Individuals with a family history - genetic predispositions including chemical imbalances and gene mutations can be inherited from parents increasing risk of mental disorders such as schizophrenia and bipolar
  • ATSI - ATSI aged 18 and over were nearly 1.5 times more likely to report experiencing at least one stressor at 82% in comparison to non-ATSI at 57%.(2002 ABS General Social Survey) The most prevalent stressors include the loss of a family member or loved one, severe illness or injury and unemployment. This resulted in ATSI having a 1.4 times higher hospitalisation rate for mental disorders than the non-ATSI population in 2001/02.
  • the DALY rate of mental disorders for ATIS is 1,6 times higher than that of the total Australian population
  • Individuals regularly exposed to a stressful environment
  • Individuals who have experienced trauma and loss in their life, such as loss of a loved one, or breakdown of family
  • Individuals with certain personality types - for example, perfectionists, heavily introverted and those with low self esteem can contribute to onset of mental disorders including anxiety and depression