Mental health describes a level of psychological well-being, or an absence of a mental disorder.^[1][2] From the perspective of 'positive psychology' or 'holism', mental health may include an individual's ability to enjoy life, and create a balance between life activities and efforts to achieve psychological resilience.^[1] Mental health can also be defined as an expression of emotions, and as signifying a successful adaptation to a range of demands.

The World Health Organization defines mental health as "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".^[3] It was previously stated that there was no one "official" definition of mental health. Cultural differences, subjective assessments, and competing professional theories all affect how "mental health" is defined.^[4] There are different types of mental health problems, some of which are common, such as depression and anxiety disorders, and some not so common, such as schizophrenia and Bipolar disorder.^[5]

Most recently, the field of Global Mental Health has emerged, which has been defined as 'the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide'.^[6]

History[link]

In the mid-19th century, William Sweetzer was the first to clearly define the term "mental hygiene", which can be seen as the precursor to contemporary approaches to work on promoting positive mental health.^[7] Isaac Ray, one of thirteen founders of the American Psychiatric Association, further defined mental hygiene as an art to preserve the mind against incidents and influences which would inhibit or destroy its energy, quality or development.^[7]

An important figure to "mental hygiene", would be Dorothea Dix (1802–1887), a school teacher, who had campaigned her whole life in order to help those suffering of a mental illness, and to bring to light the deplorable conditions which they were put it in.^[8] This was known as the "mental hygiene movement".^[8] Before this movement, it was not uncommon that people affected by mental illness in the 19th century would be considerably neglected, often left alone in deplorable conditions, barely even having sufficient clothing.^[8] Dix's efforts were so great that there was a rise in the number of patients in mental health facilities, which sadly resulted in these patients receiving less attention and care, as these institutions were largely understaffed.^[8]

At the beginning of the 20th century, Clifford Beers founded the National Committee for Mental Hygiene and opened the first outpatient mental health clinic in the United States of America.^[7][9]

The mental hygiene movement, also known as the social hygiene movement, had at times been associated with advocating eugenics and sterilisation of those considered too mentally deficient to be assisted into productive work and contented family life.^[10]

Significance[link]

Evidence from the World Health Organization suggests that nearly half the world's population are affected by mental illness with an impact on their self-esteem, relationships and ability to function in everyday life.^[11] An individual's emotional health can also impact physical health and poor mental health can lead to problems such as substance abuse.^[12]

The importance of maintaining good mental health is crucial to living a long and healthy life. Good mental health can enhance one’s life, while poor mental health can prevent someone from living a normal life. According to Richards, Campania, & Muse-Burke (2010) “There is growing evidence that is showing emotional abilities are associated with prosocial behaviors such as stress management and physical health” (2010). It was also concluded in their research that people who lack emotional expression lead to misfit behaviors. These behaviors are a direct reflection of their mental health. Self-destructive acts may take place to suppress emotions. Some of these acts include drug and alcohol abuse, physical fights or vandalism.^[13]

Perspectives[link]

Mental well-being[link]

Mental health can be seen as a unstable continuum, where an individual's mental health may have many different possible values.^[14] Mental wellness is generally viewed as a positive attribute, such that a person can reach enhanced levels of mental health, even if the person does not have any diagnosed mental health condition. This definition of mental health highlights emotional well-being, the capacity to live a full and creative life, and the flexibility to deal with life's inevitable challenges.^{[citation needed]} Many therapeutic systems and self-help books offer methods and philosophies espousing strategies and techniques vaunted as effective for further improving the mental wellness of otherwise healthy people. Positive psychology is increasingly prominent in mental health.

A holistic model of mental health generally includes concepts based upon anthropological, educational, psychological, religious and sociological perspectives, as well as theoretical perspectives from personality, social, clinical, health and developmental psychology.^[15][16]

An example of a wellness model includes one developed by Myers, Sweeney and Witmer. It includes five life tasks—essence or spirituality, work and leisure, friendship, love and self-direction—and twelve sub tasks—sense of worth, sense of control, realistic beliefs, emotional awareness and coping, problem solving and creativity, sense of humor, nutrition, exercise, self care, stress management, gender identity, and cultural identity—which are identified as characteristics of healthy functioning and a major component of wellness. The components provide a means of responding to the circumstances of life in a manner that promotes healthy functioning. The population of the USA in its' majority is considered to be mostly uneducated on the subjects of mental health .^[17]

Lack of a mental disorder[link]

Mental health can also be defined as an absence of a major mental health condition (for example, a condition diagnosed in the Diagnostic and Statistical Manual of Mental Disorders for the U.S.A or the fifth chapter of the International Classification of Diseases and Related Health Problems ICD-10 Chapter V: Mental and behavioural disorders used in countries of the world other than the U.S.A) though recent evidence stemming from positive psychology suggests mental health is more than the mere absence of a mental disorder or illness. Quite simply, mental health refers to a persons health of the mind.^[18] Therefore the impact of social, cultural, physical and education can all affect someone's mental health.^[5]

Cultural and religious considerations[link]

Mental health is a socially constructed and socially defined concept; that is, different societies, groups, cultures, institutions and professions have very different ways of conceptualizing its nature and causes, determining what is mentally healthy, and deciding what interventions, if any, are appropriate.^[19] Thus, different professionals will have different cultural, class, political and religious backgrounds, which will impact the methodology applied during treatment.

Research has shown that there is stigma attached to mental illness.^[20] In the United Kingdom, the Royal College of Psychiatrists organized the campaign Changing Minds (1998–2003) to help reduce stigma.^[21]

Many mental health professionals are beginning to, or already understand, the importance of competency in religious diversity and spirituality. The American Psychological Association explicitly states that religion must be respected. Education in spiritual and religious matters is also required by the American Psychiatric Association.^[22]

Emotional Mental Health in the United States of America[link]

According to the World Health Organization in 2004, depression is the leading cause of disability in the United States of America for individuals ages 15 to 44^[23]. Absence from work in the U.S. due to depression is estimated to be in excess of $31 billion dollars per year. Depression frequently co-occurs with a variety of medical illnesses such as heart disease, cancer, and chronic pain and is associated with poorer health status and prognosis^[24]. Each year, roughly 30,000 Americans take their lives, while hundreds of thousands make suicide attempts (Centers for Disease Control and Prevention).^[25] In 2004, suicide was the 11th leading cause of death in the United States of America (Centers for Disease Control and Prevention), third among individuals ages 15–24. Despite the increasingly availability of effectual depression treatment, the level of unmet need for treatment remains high. Reducing depression within the U.S. population has been an essential priority of governmental organizations over the last decade. Mental illness, disability, and suicide are ultimately the result of a combination of biology, environment, and access to and utilization of mental health treatment. Public health policies can influence access and utilization, which subsequently may improve mental health and help to progress the negative consequences of depression and its associated disability. Emotional mental illnesses should be a particular concern in the United States of America since the U.S.A has the highest annual prevalence rates (26 percent) for mental illnesses among a comparison of 14 developing and developed countries^[26]. While approximately 80 percent of all people in the United States with a mental disorder eventually receive some form of treatment, on the average persons do not access care until nearly a decade following the development of their illness, and less than one-third of people who seek help receive minimally adequate care.^[27] Research conducted by Mental Health America found the following factors to be considerably allied with improved depression status and lower suicide rates . “Mental health resources — On average, the higher the number of psychiatrists, psychologists, and social workers per capita in a state, the lower the suicide rate. Barriers to treatment — The lower the percentage of the population reporting that they could not obtain healthcare because of costs, the lower the suicide rate and the better the state’s depression status. In addition, the lower the percentage of the population that reported unmet mental healthcare needs, the better the state’s depression status. Mental health treatment utilization — holding the baseline^{[disambiguation needed ]} level of depression in the state constant, the higher the number of antidepressant prescriptions per capita in the state, the lower the suicide rate. Socioeconomic characteristics — The more educated the population and the greater the percentage with health insurance, the lower the suicide rate. The more educated the population, the better the state’s depression status. Mental health policy — The more generous a state’s mental health parity coverage, the greater the number of people in the population that receive mental health services.

Emotional Mental Health Issues Across The World[link]

Emotional mental disorders are a leading cause of disabilities worldwide. Investigating the degree and severity of untreated emotional mental disorders throughout the world is a top priority of the World Mental Health (WMH) survey initiative, which was created in 1998 by the World Health Organization (WHO).^[28] “Neuropsychiatric disorders are the leading causes of disability worldwide, accounting for 37% of all healthy life years lost through disease.These disorders are most destructive to low and middle-income countries due to their inability to provide their citizens with proper aid. Despite modern treatment and rehabilitation for emotional mental health disorders, “even economically advantaged societies have competing priorities and budgetary constraints”. The World Mental Health survey initiative has suggested a plan for countries to redesign their mental health care systems to best allocate resources. “A first step is documentation of services being used and the extent and nature of unmet needs for treatment. A second step could be to do a cross-national comparison of service use and unmet needs in countries with different mental health care systems. Such comparisons can help to uncover optimum financing, national policies, and delivery systems for mental health care.” Knowledge of how to provide effective emotional mental health care has become imperative worldwide. Unfortunately, most countries have insufficient data to guide decisions, absent or competing visions for resources, and near constant pressures to cut insurance and entitlements. WMH surveys were done in Africa (Nigeria, South Africa), the Americas (Colombia, Mexico, U.S.A), Asia and the Pacific (Japan, New Zealand, Beijing and Shanghai in the Peoples Republic of China), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), and the middle east (Israel, Lebanon). Countries were classified with World Bank criteria as low-income (Nigeria), lower middle-income (China, Columbia, South Africa, Ukraine), higher middle-income (Lebanon, Mexico), and high-income. The coordinated surveys on emotional mental health disorders, their severity, and treats were implemented in afore mentioned countries. These surveys assessed the frequency, types, and adequacy of mental health service use in 17 countries in which WMH surveys are complete. The WMH also examined unmet needs for treatment in strata defined by the seriousness of mental disorders. Their research showed that “the number of respondents using any 12- month mental health service was generally lower in developing than in developed countries, and the proportion receiving services tended to correspond to countries’ percentages of gross domestic product spent on health care”. “High levels of unmet need worldwide are not surprising, since WHO Project ATLAS' findings of much lower mental health expenditures than was suggested by the magnitude of burdens from mental illnesses. Generally, unmet needs in low-income and middle-income countries might be attributable to these nations spending reduced amounts (usually <1%) of already diminished health budgets on mental health care, and they rely heavily on out-of-pocket spending by citizens who are ill equipped for it”.

Emotional mental health improvement[link]

Being mentally and emotionally healthy does not exclude the experiences of life which we cannot control. As humans we are going to face emotions and events that are a part of life. According to Smith and Segal, “People who are emotionally and mentally healthy have the tools for coping with difficult situations and maintaining a positive outlook in which also remain focused, flexible, and creative in bad times as well as good”^[29] (2011). In order to improve your emotional mental health the root of the issue has to be resolved. “Prevention emphasizes the avoidance of risk factors; promotion aims to enhance an individual’s ability to achieve a positive sense of self-esteem, mastery, well-being, and social inclusion”^[30] (Power, 2010). It is very important to improve your emotional mental health by surrounding yourself with positive relationships. We as humans, feed off companionships and interaction with other people. Another way to improve your emotional mental health is participating in activities that can allow you to relax and take time for yourself. Yoga is a great example of its meditating aspect which calms your entire body and nerves. According to a study on well-being Richards, Campania and Muse-Burke found, “mindfulness is considered to be a purposeful state, it may be that those who practice it believe in its importance and value being mindful, so that valuing of self-care activities may influence the intentional component of mindfulness”^[31] (2010).

Emotional mental ill-health prevention[link]

Prevention is beginning to appear in mental health strategies, including the 2004 WHO report "Prevention of Mental Disorders", the 2008 EU "Pact for Mental Health" and the 2011 US National Prevention Strategy.^[32]

Mental Health Policies in the United States[link]

The mental health policies in the United States have experienced four major reforms: the American asylum movement led by Dorothea Dix in 1843; the “mental hygiene” movement inspired by Clifford Beers in 1908; the deinstitutionalization started by Action for Mental Health in 1961; and the community support movement called by The CMCH Act Amendments of 1975.^[33]

In 1843, Dorothea Dix submitted a Memorial to the Legislature of Massachusetts, describing the abusive treatment and horrible conditions received by the mentally ill patients in jails, cages, and almshouses. She revealed in her Memorial: “I proceed, gentlemen, briefly to call your attention to the present state of insane persons confined within this Commonwealth, in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience. . . .”^[34] Many asylums were built at that period, with high fences or walls separating the patients from other community members and strict rules regarding the entrance and exit. In those asylums, traditional treatments were well implemented: drugs were not used as a cure for a disease, but a way to reset equilibrium in a person’s body, along with other essential elements such as healthy diets, fresh air, middle class culture, and the visits by their neighboring residents. In 1866, a recommendation came to the New York State Legislature to establish a separate asylum for chronic mentally ill patients. Some hospitals placed the chronic patients into separate wings or wards, or different buildings. ^[35]

In 1908, Clifford Whittingham Beers finished his first edition of an astonishing book, A Mind That Found Itself, describing the humiliating treatment he received and the deplorable conditions in the mental hospital. ^[36] One year later, the National Committee for Mental Hygiene (NCMH) was founded by a small group of reform-minded scholars and scientist – including Beer himself – which marked the beginning of the “mental hygiene” movement. The movement emphasized the importance of childhood prevention; the World War I catalyzed this idea with an additional emphasis on the impact of maladjustment, which convinced the hygienists that prevention was the only practical approach to handle mental health issue.^[37] However, The prevention was not successful, especially for chronic illness; the condemnable conditions in the hospitals were even more prevalent, especially under the pressure of the increasing number of chronically ill and the influence of the Depression.^[38]

In 1961, the Joint Commission on Mental Health published a report called Action for Mental Health, whose goal was for community clinic care to take on the burden of prevention and early intervention of the mental illness, therefore to leave space in the hospitals for severe and chronic patients. The court started to rule in favor of the patients' will on whether they should be forced to treatment. By 1977, 650 community mental health centers were built to cover 43 percent of the population and serve 1.9million individuals a year, and the lengths of treatment decreased from 6 months to only 23 days. ^[39] However, issues still existed. Due to the inflation especially in the 1970s, the community nursing homes received less money to support the care and treatment provided. Fewer than half of the planned centers were created, and new equipment didn’t fully replace the old approaches to carry out its full capacity of treating power. ^[40] Besides, the community helping system was not fully established to support the patients’ housing, vocational opportunities, income supports, and other benefits. ^[41] Many patients returned to welfare and criminal justice institutions, and more became homeless. The movement of deinstitutionalization was facing great fractions.

After realizing that simply changing the location of mental health care from the state hospitals to nursing houses was insufficient to implement the idea of deinstitutionalization, the National Institute of Mental Health in 1975 created the Community Support Program (CSP) to provide funds for communities to set up a comprehensive mental health service and supports to help the mentally ill patients integrate successfully in the society. The program stressed the importance of other supports in addition to medical care, including housing, living expenses, employment, transportation, and education; and set up new national priority for people with serious mental disorders. In addition, the Congress enacted the Mental Health Systems Act to prioritize the service to the mentally ill and emphasize the expansion of services beyond just clinical care alone. ^[42] Later in the 1980s, under the influence from the Congress and the Supreme Court, many programs started to help the patients regain their benefits. A new Medicaid service was also established to serve people who were suffering from a “chronic mental illness.” People who were temporally hospitalized were also provided aid and care and a pre-release program were created to enable people to apply for reinstatement prior to discharge.^[43] Not until 1990, around 35 years after the start of the deinstitutionalization, did the first state hospital begin to close. The number of hospitals dropped from around 300 by over 40 in the 1990s, and finally a Report on Mental Health showed the efficacy of mental health treatment, giving a range of treatments available for patients to choose.^[44]

The 2011 National Prevention Strategy included mental and emotional well-being, with recommendations including better parenting and early intervention programmes, which increases the likelihood of prevention programmes being included in future US mental health policies.^{[45] [46]} The NIMH is currently only researching suicide and HIV/AIDS prevention, but the National Prevention Strategy could lead to it focusing more broadly on longitudinal prevention studies.^[47]

See also[link]

Psychology portal

• Global Mental Health
• Health
• Infant mental health
• Mental health law
• Public health
• Self-help groups for mental health
• mental health first aid

Related concepts[link]

• Dissociation
• Mental disorder
• Mental environment
• Mental health professional
• Mental Illness
• Reason
• Sanity
• Structured Clinical Interview for DSM-IV
• Technology and mental health issues

Related disciplines and specialties[link]

• DSM-IV Codes
• Positive psychology
• Psychiatric nurse
• Psychiatry
• Psychology
• Social work
• Youth Health

References[link]

External links[link]

• History of Camarillo State Mental Hospital, open 1936 - 1997, housing 7,000 patients at a time, and leader in psychiatric experimentation
• International Mental Health
• Mental Health Department of Health (United Kingdom)
• NHS Confederation Mental Health Network
• UK Mental Health Resource
• National Institute of Mental Health (United States)
• Mental Health Directory
• Australian Network for Promotion, Prevention and Early Intervention for Mental Health
• The National Mental Health Development Unit (NMHDU), England
• Health-EU Portal Mental Health in the EU
• Technology to Help Treat People with Mental Health Problems