What Is Mental Health?

Mental health includes our emotional, psychological, and social

well-being. It affects how we think, feel, and act. It also helps determine how we handle
stress, relate to others, and make choices. Mental health is important at every stage of
life, from childhood and adolescence through adulthood.

Over the course of your life, if you experience mental health problems, your thinking, mood,
and behavior could be affected. Many factors contribute to mental health problems, including:

Biological factors, such as genes or brain chemistry Life experiences, such as trauma or
abuse Family history of mental health problems Mental health problems are common but help
is available. People with mental health problems can get better and many recover completely.

Early Warning Signs Not sure if you or someone you know is living with mental health problems?
Experiencing one or more of the following feelings or behaviors can be an early warning sign
of a problem:

Eating or sleeping too much or too little Pulling away from people and usual activities Having
low or no energy Feeling numb or like nothing matters Having unexplained aches and pains
Feeling helpless or hopeless Smoking, drinking, or using drugs more than usual Feeling
unusually confused, forgetful, on edge, angry, upset, worried, or scared Yelling or fighting
with family and friends Experiencing severe mood swings that cause problems in relationships
Having persistent thoughts and memories you can't get out of your head Hearing voices or
believing things that are not true Thinking of harming yourself or others Inability to perform
daily tasks like taking care of your kids or getting to work or school Learn more about
specific mental health problems and where to find help. Mental Health and Wellness Positive
mental health allows people to: Realize their full potential Cope with the stresses of life
Work productively Make meaningful contributions to their communities Ways to maintain
positive mental health include: Getting professional help if you need it Connecting with
others Staying positive Getting physically active Helping others Getting enough sleep
Developing coping skills

Mental Health Everyone feels worried or anxious or down from time to time. But relatively
few people develop a mental illness. What's the difference? A mental illness is a mental
health condition that gets in the way of thinking, relating to others, and day-to-day
function.

Dozens of mental illnesses have been identified and defined. They include depression,
generalized anxiety disorder, bipolar disorder, obsessive-compulsive disorder,
post-traumatic stress disorder, schizophrenia, and many more.
Mental illness is an equal opportunity issue. It affects young and old, male and female,
and individuals of every race, ethnic background, education level, and income level. The
good news is that it can often be treated.

Signs and symptoms of mental illness depend in part on the illness. Common symptoms include

feeling down for a while extreme swings in mood withdrawing from family, friends, or
activities low energy or problems sleeping often feeling angry, hostile, or violent feeling
paranoid, hearing voices, or having hallucinations often thinking about death or suicide.
In some people, symptoms of a mental illness first appear as physical problems such as stomach
aches, back pain, or insomnia.

Individuals with a mental illness can often ease their symptoms and feel better by talking
with a therapist and following a treatment plan that may or may not include medication.

The signs of mental illness aren't always obvious. Subtle changes in mood or behavior are
often attributed to aging, just like weaker muscles and fuzzy thinking. "There's a tendency
to dismiss it as, 'Well, of course I'm worried, I have heart disease,' or, 'Of course I'm
sad, I'm not as relevant as I once was,'" says Dr. Michael Craig Miller, an assistant professor
of psychiatry at Harvard Medical School.

But depression (extreme sadness, worthlessness, or hopelessness) and anxiety (debilitating

worry and agitation) do not need to be routine parts of aging. Getting help for these feelings
can help you maintain your health and enjoy life to the fullest.

How meditation helps with depression A regular practice can help your brain better manage
stress and anxiety that can trigger depression. Published: August, 2018

Depression continues to be a major health issue for older adults. It affects about 20% of
adults ages 65 and older, and regular depression can lead to higher risks for heart disease
and death from illnesses. It also affects people's daily lives by making them more socially
isolated and affecting cognitive function,especially memory.
Protect your brain from stress Stress management may reduce health problems linked to stress,
which include cognitive problems and a higher risk for Alzheimer's disease and dementia.
Published: August, 2018 Image: © iMrSquid/Getty Images It's not uncommon to feel disorganized
and forgetful when you're under a lot of stress. But over the long term, stress may actually
change your brain in ways that affect your memory. Studies in both animals and people show
pretty clearly that stress can affect how the brain functions, says Dr. Kerry Ressler, chief
scientific officer at McLean Hospital and professor of psychiatry at Harvard Medical School.
Scientists have seen changes in how the brain processes information when people experience
either real-life stress or stress manufactured in a research setting. (For the latter,
researchers might challenge subjects to perform a difficult task, such as counting backward
from the number 1,073 by 13s while being graded.) Either type of stress seems to interfere
with cognition, attention, and memory, he says. Stress affects not only memory and many other
brain functions, like mood and anxiety, but also promotes inflammation, which adversely
affects heart health, says Jill Goldstein, a professor of psychiatry and medicine at Harvard
Medical School. Thus, stress has been associated with multiple chronic diseases of the brain
and heart. In addition, it can affect men and women differently, she says. Stress and the
brain To understand why stress affects thinking and memory, it's important to understand
a little about how the brain works. Your brain isn't just a single unit, but a group of
different parts that perform different tasks, says Dr. Ressler. Researchers believe that
when one part of your brain is engaged, the other parts of your brain may not have as much
energy to handle their own vital tasks, he says. For example, if you are in a dangerous or
emotionally taxing situation, the amygdala (the part of your brain that governs your survival
instincts) may take over, leaving the parts of your brain that help to store memories and
perform higher-order tasks with less energy and ability to get their own jobs done. "The
basic idea is that the brain is shunting its resources because it's in survival mode, not
memory mode," says Dr. Ressler. This is why you might be more forgetful when you are under
stress or may even experience memory lapses during traumatic events. The effect that stress
has on the brain and body may also differ depending on when it occurs in the course of someone's
life, says Goldstein. Certain hormones, known as gonadal hormones — which are secreted in
large amounts during fetal development, puberty, and pregnancy and depleted during menopause
— may play a role in how stress affects an individual, says Goldstein. "For example,
reductions in the gonadal hormone estradiol during the menopausal transition may change how
our brain responds to stress," she says. Protect yourself from damaging stress To better
cope with stress, consider how you might minimize factors that make it worse. Here are some
tips that can help you better manage stress and hopefully prevent some of the damaging effects
it could have on your brain. Establish some control over your situation. If stress isn't
predictable, focus on controlling the things that are. "Having a routine is good for
development and health," says Dr. Kerry Ressler, professor of psychiatry at Harvard Medical
School. Predictability combats stress. Get a good night's sleep. Stress can result in sleep
difficulties, and the resulting lack of sleep can make stress worse. "Sleep deprivation makes
parts of the brain that handle higher-order functions work less well," says Dr. Ressler.
Having healthy sleep habits can help. This includes going to bed and waking up at the same
time each day, avoiding caffeine after noon, and creating a relaxing sleep environment. Get
organized. Using strategies to help manage your workload can also reduce stress. For example,
each day, create a concrete list of tasks you need to accomplish. This way, your duties won't
seem overwhelming. Making a list also gives you a clear end point so you know when you are
done. "Laying tasks out like this helps reduce the feeling that the brain is being bombarded,"
he says. It can also help you predict when you are likely to be stressed. Get help if you
need it. Reaching out can help you become more resilient and better able to manage stress,
which may ultimately protect your brain health. Earlier intervention may reduce disability
caused by stress-related complications later on. Change your attitude toward stress. "A life
without stress is not only impossible, but also would likely be pretty uninteresting — in
fact, a certain degree of stress is helpful for growth," says Dr. Ressler. So, rather than
striving for no stress, strive for healthier responses to stress. Long-term brain changes
There is evidence that chronic (persistent) stress may actually rewire your brain, says Dr.
Ressler. Scientists have learned that animals that experience prolonged stress have less
activity in the parts of their brain that handle higher-order tasks — for example, the
prefrontal cortex — and more activity in the primitive parts of their brain that are focused
on survival, such as the amygdala. It's much like what would happen if you exercised one
part of your body and not another. The part that was activated more often would become stronger,
and the part that got less attention would get weaker, he says. This is what appears to happen
in the brain when it is under continuous stress: it essentially builds up the part of the
brain designed to handle threats, and the part of the brain tasked with more complex thought
takes a back seat. These brain changes may be reversible in some instances, says Dr. Ressler,
but may be more difficult to reverse in others, depending on the type and the duration of
the stress. While stressful childhood experiences seem to take more of a toll on the
developing brain, some research has found that people who demonstrate resilience in the face
of past childhood trauma actually appear to have generated new brain mechanisms to compensate.
It's thought that these new pathways help to overcome stress-related brain changes that
formed earlier in life, he says. Is all stress created equal? While the effect of stress
on the brain is well documented, it's less clear exactly what type of stress will prove
damaging and raise the risk of memory problems later in life. Do brain problems occur when
you are under a small amount of stress or only when you experience long-term stress? "That's
a tough question, because stress is a broad term that is used to describe a lot of different
things," says Dr. Ressler. The stress you might experience before you take a test is likely
very different from the stress of being involved in a car accident or from a prolonged illness.
"Certainly, more stress is likely worse, and long-term stress is generally worse than
short-term stress," says Dr. Ressler. But there are additional factors that make stress more
harmful, he says. In particular: The stress is unpredictable. Animal research shows that
animals that could anticipate a stressor — for example, they received a shock after a light
turned on — were less stressed than animals that received the same number of shocks randomly.
The same is true in humans, says Dr. Ressler. If a person can anticipate stress, it is less
damaging than stress that appears to be more random. There is no time limit on the stress.
If you are stressed about a presentation at work or an upcoming exam, the stress you are
experiencing has an end point when you know you will get relief. If the stress has no end
point — for example, you are chronically stressed about finances — it may be more
challenging to cope with. You lack support. If you feel supported during your stress, you
are likely to weather it more successfully than if you don't.
Holding on to stress could affect health Research we're watching holding on to
stressPublished: July, 2018 If you're able to quickly shrug off stressful events, that may
be good for your health. A study in the March 19 issue of Psychological Science found that
people who held on to stress—those who reported still having negative feelings about a
stressful event the day after it happened — had more chronic health problems a decade later.

Researchers analyzed data from a nationwide survey that asked more than 1,100 adults about
the number and type of stressful experiences they had each day for eight days. These included
everything from arguments with others to problems at work, home, or school. Participants
rated their emotional reactions to these stressors at the time and afterward.

The researchers then followed up nearly 10 years later and asked participants about their
health and mobility, including whether they suffered from any of 26 different chronic
diseases, including heart disease, cancer, autoimmune disorders, and joint or pain
conditions, among others. The participants were also asked to rate how much their health
interfered with their daily life.The results suggest that holding on to stress may be
problematic for your health and learning how to better cope with stress and increase
resiliency might be helpful in preventing these problems and protecting your health for the
long term.

How atrial fibrillation may affect your brain This heart rhythm disorder is linked to thinking
and memory problems. But anti-clotting drugs may lower the risk. Published: July, 2018 Bouts
of atrial fibrillation, or afib — a rapid, chaotic heartbeat — make some people feel
lightheaded and dizzy, while others don't notice any symptoms. But the most serious threat
of this condition is the higher risk of stroke among people with afib compared with those
without the disorder (see "Blood clot dangers, large and small"). Now, there's a growing
recognition that people with afib also face an increased risk of thinking and memory problems
— even if they do not experience a stroke. Known as cognitive impairment, these problems
include trouble remembering, learning new things, concentrating, or making routine decisions.
The presumed underlying cause? Tiny blood clots that cause "silent" (that is, unrecognized)
strokes and gradually injure parts of the brain involved with cognition.

"Many men are at higher risk for mood disorders as they age, from dealing with sudden life
changes like health issues, the loss of loved ones, and even the new world of retirement,"
says Dr. Jason Strauss, director of geriatric psychiatry at Harvard-affiliated Cambridge
Health Alliance. "They may not want to turn to medication or therapy for help, and for many,
interacting with nature is one of the best self-improvement tools they can use." Your brain
and nature Research in a growing scientific field called ecotherapy has shown a strong
connection between time spent in nature and reduced stress, anxiety, and depression. It's
not clear exactly why outdoor excursions have such a positive mental effect. Yet, in a 2015
study, researchers compared the brain activity of healthy people after they walked for 90
minutes in either a natural setting or an urban one. They found that those who did a nature
walk had lower activity in the prefrontal cortex, a brain region that is active during
rumination — defined as repetitive thoughts that focus on negative emotions. "When people
are depressed or under high levels of stress, this part of the brain malfunctions, and people
experience a continuous loop of negative thoughts," says Dr. Strauss. Digging a bit deeper,
it appears that interacting with natural spaces offers other therapeutic benefits. For
instance, calming nature sounds and even outdoor silence can lower blood pressure and levels
of the stress hormone cortisol, which calms the body's fight-or-flight response. The visual
aspects of nature can also have a soothing effect, according to Dr. Strauss. "Having something
pleasant to focus on like trees and greenery helps distract your mind from negative thinking,
so your thoughts become less filled with worry." Bringing the outdoors inside If you can't
make it outside, listening to nature sounds can have a similar effect, suggests a report
published online March 27, 2017, by Scientific Reports. Researchers used an MRI scanner to
measure brain activity in people as they listened to sounds recorded from either natural
or artificial environments. Listening to natural sounds caused the listeners' brain
connectivity to reflect an outward-directed focus of attention, a process that occurs during
wakeful rest periods like daydreaming. Listening to artificial sounds created an
inward-directed focus, which occurs during states of anxiety, post-traumatic stress disorder,
and depression. Even looking at pictures of nature settings, your favorite spot, or a place
you want to visit can help. Find your space How much time with nature is enough? "Anything
from 20 to 30 minutes, three days a week, to regular three-day weekends in the woods is
helpful," says Dr. Strauss. "The point is to make your interactions a part of your normal
lifestyle." Your time with nature could be something as simple as a daily walk in a park
or a Saturday afternoon on a local trail. "You can even try to combine your nature outings
with your regular exercise by power walking or cycling outdoors," says Dr. Strauss. The type
of nature setting doesn't matter, either. "Focus on places you find the most pleasing," says
Dr. Strauss. "The goal is to get away from stimulating urban settings and surround yourself
with a natural environment." And don't feel you have to go it alone. A 2014 study found that
group nature walks were just as effective as solo treks in terms of lowering depression and
stress and improving overall mental outlook. In fact, the researchers noted that people who
had recently experienced stressful life events like a serious illness, death of a loved one,
or unemployment had the greatest mental boost from a group nature outing. "Nature can have
a powerful effect on our mental state," says Dr. Strauss, "and there are many ways to tap
into it."

Mental Health Email this page to a friend Print Facebook Twitter Google+ Subscribe to RSS
On this page Basics Summary Start Here Diagnosis and Tests Treatments and Therapies Learn
More Related Issues Specifics See, Play and Learn No links available Research Statistics
and Research Clinical Trials Journal Articles Resources Find an Expert For You Children
Teenagers Women Patient Handouts Summary What is mental health? Mental health includes our
emotional, psychological, and social well-being. It affects how we think, feel, and act as
we cope with life. It also helps determine how we handle stress, relate to others, and make
choices. Mental health is important at every stage of life, from childhood and adolescence
through adulthood. What are mental illnesses? Mental illnesses are serious disorders which
can affect your thinking, mood, and behavior. They may be occasional or long-lasting. They
can affect your ability to relate to others and function each day. Mental disorders are common;
more than half of all Americans will be diagnosed with a mental disorder at some time in
their life. But there are treatments. People with mental health problems can get better,
and many of them recover completely. Why is mental health important? Mental health is
important because it can help you to Cope with the stresses of life Be physically healthy
Have good relationships Make meaningful contributions to your community Work productively
Realize your full potential How can I improve my mental health? There are steps you can take
to help you improve your mental health. They include Staying positive Being physically active
Connecting with others Developing a sense of meaning and purpose in life Getting enough sleep
Developing coping skills Meditating Getting professional help if you need it Start Here Live
Your Life Well (Mental Health America) Mental Health: Keeping Your Emotional Health (American
Academy of Family Physicians) Also in Spanish Mind/Body Connection: How Your Emotions Affect
Your Health (American Academy of Family Physicians) Also in Spanish Positive Emotions and
Your Health: Developing a Brighter Outlook From the National Institutes of Health (National
Institutes of Health) Also in Spanish What Is Mental Health? (Department of Health and Human
Services) Diagnosis and Tests Mental Health: What's Normal, What's Not? (Mayo Foundation
for Medical Education and Research) Treatments and Therapies Meditation From the National
Institutes of Health (National Center for Complementary and Integrative Health) Relaxation
Techniques for Health From the National Institutes of Health (National Center for
Complementary and Integrative Health) Yoga for Health From the National Institutes of Health
(National Center for Complementary and Integrative Health) Related Issues Building Social
Bonds: Connections That Promote Well-Being From the National Institutes of Health (National
Institutes of Health) Also in Spanish For a Healthy Mind and Body Talk to a Psychologist
(American Psychological Association) Also in Spanish Forgiveness: Letting Go of Grudges and
Bitterness (Mayo Foundation for Medical Education and Research) Friendships: Enrich Your
Life and Improve Your Health (Mayo Foundation for Medical Education and Research) How to
Be Happy: Tips for Cultivating Contentment (Mayo Foundation for Medical Education and
Research) Also in Spanish Mental Health and Heart Health (American Heart Association)
Mindfulness Exercises: How to Get Started (Mayo Foundation for Medical Education and Research)
Road to Resilience (American Psychological Association) Also in Spanish Specifics Anger
Management (Mayo Foundation for Medical Education and Research) Building Self-Esteem: A
Self-Help Guide (Center for Mental Health Services) - PDF Creating a Healthier Life: A
Step-By-Step Guide to Wellness (Substance Abuse and Mental Health Services Administration)
- PDF Latino Mental Health (NAMI) Self-Esteem Check: Too Low, Too High or Just Right? (Mayo
Foundation for Medical Education and Research) Statistics and Research Do Social Ties Affect
Our Health? Exploring the Biology of Relationships From the National Institutes of Health
(National Institutes of Health) Also in Spanish Clinical Trials ClinicalTrials.gov: Mental
Health From the National Institutes of Health (National Institutes of Health) Journal
Articles References and abstracts from MEDLINE/PubMed (National Library of Medicine) Article:
Qualitative evaluation of mental health training of auxiliary nurse midwives... Article:
Mental health of Automobile Transportation Troop personnel stationed in the... Article:
Welfare-to-work interventions and their effects on the mental and physical... Mental Health
-- see more articles Find an Expert American Psychiatric Association National Institute of
Mental Health From the National Institutes of Health Substance Abuse and Mental Health
Services Administration Children Child Mental Health: MedlinePlus Health Topic From the
National Institutes of Health (National Library of Medicine) Also in Spanish Teenagers Teen
Mental Health: MedlinePlus Health Topic From the National Institutes of Health (National
Library of Medicine) Also in Spanish Women Good Mental Health (Department of Health and Human
Services, Office on Women's Health) Women's Mental Health (Substance Abuse and Mental Health
Services Administration) - PDF Patient Handouts Learn to manage your anger (Medical
Encyclopedia) Also in Spanish

History
The term mental model is believed to have originated with Kenneth Craik in his 1943 book
The Nature of Explanation.[1][2] Georges-Henri Luquet in Le dessin enfantin (Children's
drawings), published in 1927 by Alcan, Paris, argued that children construct internal models,
a view that influenced, among others, child psychologist Jean Piaget.

Philip Johnson-Laird published Mental Models: Towards a Cognitive Science of Language,

Inference and Consciousness in 1983. In the same year, Dedre Gentner and Albert Stevens edited
a collection of chapters in a book also titled Mental Models.[3] The first line of their
book explains the idea further: "One function of this chapter is to belabor the obvious;
people's views of the world, of themselves, of their own capabilities, and of the tasks that
they are asked to perform, or topics they are asked to learn, depend heavily on the
conceptualizations that they bring to the task." (see the book: Mental Models).

Since then, there has been much discussion and use of the idea in human-computer interaction
and usability by researchers including Donald Norman and Steve Krug (in his book Don't Make
Me Think). Walter Kintsch and Teun A. van Dijk, using the term situation model (in their
book Strategies of Discourse Comprehension, 1983), showed the relevance of mental models
for the production and comprehension of discourse.

Mental models and reasoning

One view of human reasoning is that it depends on mental models. In this view, mental models
can be constructed from perception, imagination, or the comprehension of discourse
(Johnson-Laird, 1983). Such mental models are similar to architects' models or to physicists'
diagrams in that their structure is analogous to the structure of the situation that they
represent, unlike, say, the structure of logical forms used in formal rule theories of
reasoning. In this respect, they are a little like pictures in the picture theory of language
described by philosopher Ludwig Wittgenstein in 1922. Philip Johnson-Laird and Ruth M.J.
Byrne developed a theory of mental models which makes the assumption that reasoning depends,
not on logical form, but on mental models (Johnson-Laird and Byrne, 1991).

Principles of mental models

Mental models are based on a small set of fundamental assumptions (axioms), which distinguish
them from other proposed representations in the psychology of reasoning (Byrne and
Johnson-Laird, 2009). Each mental model represents a possibility. A mental model represents
one possibility, capturing what is common to all the different ways in which the possibility
may occur (Johnson-Laird and Byrne, 2002). Mental models are iconic, i.e., each part of a
model corresponds to each part of what it represents (Johnson-Laird, 2006). Mental models
are based on a principle of truth: they typically represent only those situations that are
possible, and each model of a possibility represents only what is true in that possibility
according to the proposition. However, mental models can represent what is false, temporarily
assumed to be true, for example, in the case of counterfactual conditionals and
counterfactual thinking (Byrne, 2005).

Reasoning with mental models

People infer that a conclusion is valid if it holds in all the possibilities. Procedures
for reasoning with mental models rely on counter-examples to refute invalid inferences; they
establish validity by ensuring that a conclusion holds over all the models of the premises.
Reasoners focus on a subset of the possible models of multiple-model problems, often just
a single model. The ease with which reasoners can make deductions is affected by many factors,
including age and working memory (Barrouillet, et al., 2000). They reject a conclusion if
they find a counterexample, i.e., a possibility in which the premises hold, but the conclusion
does not (Schroyens, et al. 2003; Verschueren, et al., 2005).

Criticisms
Scientific debate continues about whether human reasoning is based on mental models, versus
formal rules of inference (e.g., O'Brien, 2009), domain-specific rules of inference (e.g.,
Cheng & Holyoak, 2008; Cosmides, 2005), or probabilities (e.g., Oaksford and Chater, 2007).
Many empirical comparisons of the different theories have been carried out (e.g., Oberauer,
2006).

Mental models of dynamics systems: mental models in system dynamics

Characteristics
A mental model is generally:

founded on unquantifiable, impugnable, obscure, or incomplete facts

flexible – is considerably variable in positive as well as in negative sense
an information filter – causes selective perception, perception of only selected parts of
information
very limited, compared with the complexities of the world, and even when a scientific model
is extensive and in accordance with a certain reality in the derivation of logical
consequences of it, it must take into account such restrictions as working memory; i.e.,
rules on the maximum number of elements that people are able to remember, gestaltisms or
failure of the principles of logic, etc.
dependent on sources of information, which one can not find anywhere else, are available
at any time and can be used.[4][5][6]
Mental models are a fundamental way to understand organizational learning. Mental models,
in popular science parlance, have been described as "deeply held images of thinking and
acting".[7] Mental models are so basic to understanding the world that people are hardly
conscious of them.

Expression of mental models of dynamic systems

S.N. Groesser and M. Schaffernicht (2012) describe three basic methods which are typically
used:

Causal loop diagrams – displaying tendency and a direction of information connections and
the resulting causality and feedback loops
System structure diagrams – another way to express the structure of a qualitative dynamic
system
Stock and flow diagrams - a way to quantify the structure of a dynamic system
These methods allow showing a mental model of a dynamic system, as an explicit, written model
about a certain system based on internal beliefs. Analyzing these graphical representations
has been an increasing area of research across many social science fields.[8] Additionally
software tools that attempt to capture and analyze the structural and functional properties
of individual mental models such as Mental Modeler, "a participatory modeling tool based
in fuzzy-logic cognitive mapping",[9] have recently been developed and used to
collect/compare/combine mental model representations collected from individuals for use in
social science research, collaborative decision-making, and natural resource planning.

Mental model in relation to system dynamics and systemic thinking

In the simplification of reality, creating a model can find a sense of reality, seeking to
overcome systemic thinking and system dynamics.

These two disciplines can help to construct a better coordination with the reality of mental
models and simulate it accurately. They increase the probability that the consequences of
how to decide and act in accordance with how to plan.[4]

System dynamics – extending mental models through the creation of explicit models, which
are clear, easily communicated and can be compared with each other.
Systemic thinking – seeking the means to improve the mental models and thereby improve the
quality of dynamic decisions that are based on mental models.
Single and double-loop learning
After analyzing the basic characteristics, it is necessary to bring the process of changing
the mental models, or the process of learning. Learning is a back-loop process, and feedback
loops can be illustrated as: single-loop learning or double-loop learning.

Single-loop learning
Mental models affect the way people work with the information and determine the final decision.
The decision itself changes, but the mental models remain the same. It is the predominant
method of learning, because it is very convenient. One established mental model is fixed,
so the next decision is very fast.

Double-loop learning
Main article: Double-loop learning
Double-loop learning (see diagram below) is used when it is necessary to change the mental
model on which a decision depends. Unlike single loops, this model includes a shift in
understanding, from simple and static to broader and more dynamic, such as taking into account
the changes in the surroundings and the need for expression changes in mental models.[5]

Nersessian, Nancy J. (1992). "In the Theoretician's Laboratory: Thought Experimenting as

Mental Modeling" (PDF). PSA: Proceedings of the Biennial Meeting of the Philosophy of Science
Association. 1992: 291–301. doi:10.1086/psaprocbienmeetp.1992.2.192843. Retrieved 17 July
2014. The contemporary notion that mental modelling plays a significant role in human
reasoning was formulated, initially, by Kenneth Craik in 1943.
Staggers, Nancy; Norcio, A.F. (1993). "Mental models: concepts for human-computer
interaction research" (PDF). International Journal of Man-Machine Studies. 38 (4): 587–
605. doi:10.1006/imms.1993.1028. Retrieved 17 July 2014. Although Johnson-Laird (1989) is
generally credited with coining the term mental model, the history of the concept may be
traced to Craik's (1943) work entitled The Nature of Explanation.
"Mental models", report at www.lauradove.info.
Šusta, Marek. "Několik slov o systémové dynamice a systémovém myšlení" (PDF) (in Czech).
Proverbs, a.s. pp. 3–9. Retrieved 2009-01-15.
Mildeova, S., Vojtko V. (2003). Systémová dynamika (in Czech). Prague: Oeconomica. pp. 19–
24. ISBN 80-245-0626-2.
Ford, David N., Sterman, John D. "Expert Knowledge Elicitation to Improve Mental and Formal
Models" (PDF). Cambridge, Massachusetts, US - Massachusetts Institute of Technology. pp.
18–23. Retrieved 2009-01-11.
"Leading for a Change", Ralph Jacobson, 2000, Chapter 5, Page102
Natalie, Jones,; Helen, Ross,; Timothy, Lynam,; Pascal, Perez,; Anne, Leitch, (24 March 2011).
"Mental Models: An Interdisciplinary Synthesis of Theory and Methods". Ecology and Society.
16 (1). doi:10.5751/ES-03802-160146. Retrieved 11 April 2018. More than one of |website=
and |journal= specified (help)
"Mental Modeler: A Fuzzy-Logic Cognitive Mapping Modeling Tool for Adaptive Environmental
Management" (PDF). mentalmodeler.org. Retrieved 11 April 2018.
References
Barrouillet, P. et al. (2000). Conditional reasoning by mental models: chronometric and
developmental evidence. Cognit. 75, 237-266.
Byrne, R.M.J. (2005). The Rational Imagination: How People Create Counterfactual
Alternatives to Reality. Cambridge MA: MIT Press.
Byrne, R.M.J. & Johnson-Laird, P.N. (2009). 'If' and the problems of conditional reasoning.
Trends in Cognitive Sciences. 13, 282-287
Cheng, P.C. and Holyoak, K.J. (2008) Pragmatic reasoning schemas. In Reasoning: studies of
human inference and its foundations (Adler, J.E. and Rips, L.J., eds), pp. 827–842,
Cambridge University Press
Cosmides, L. et al. (2005) Detecting cheaters. Trends in Cognitive Sciences. 9,505–506
Forrester, J. W. (1971) Counterintuitive behavior of social systems. Technology Review.
Oberauer K. (2006) Reasoning with conditionals: A test of formal models of four theories.
Cognit. Psychol. 53:238–283.
O’Brien, D. (2009). Human reasoning includes a mental logic. Behav. Brain Sci. 32, 96–
97
Oaksford, M. and Chater, N. (2007) Bayesian Rationality. Oxford University Press
Johnson-Laird, P.N. (1983). Mental Models: Towards a Cognitive Science of Language,
Inference, and Consciousness. Cambridge: Cambridge University Press.
Johnson-Laird, P.N. (2006) How We Reason. Oxford University Press
Johnson-Laird, P.N. and Byrne, R.M.J. (2002) Conditionals: a theory of meaning, inference,
and pragmatics. Psychol. Rev. 109, 646–678
Schroyens, W. et al. (2003). In search of counterexamples: Deductive rationality in human
reasoning. Quart. J. Exp. Psychol. 56(A), 1129–1145.
Verschueren, N. et al. (2005). Everyday conditional reasoning: A working memory-dependent
tradeoff between counterexample and likelihood use. Mem. Cognit. 33, 107-119.
Further reading
Georges-Henri Luquet (2001). Children's Drawings. Free Association Books. ISBN
1-85343-516-3
Groesser, S.N. (2012). Mental model of dynamic systems. In N.M. Seel (Ed.). The encyclopedia
of the sciences of learning (Vol. 5, pp. 2195–2200). New York: Springer.
Groesser, S.N. & Schaffernicht, M. (2012). Mental Models of Dynamic Systems: Taking Stock
and Looking Ahead. System Dynamics Review, 28(1): 46-68, Wiley.
Johnson-Laird, P.N. 2005. The History of Mental Models
Johnson-Laird, P.N., 2005. Mental Models, Deductive Reasoning, and the Brain
Jones, N. A. et al. (2011). "Mental Models: an interdisciplinary synthesis of theory and
methods" Ecology and Society.16 (1): 46.
Jones, N. A. et al. (2014). "Eliciting mental models: a comparison of interview procedures
in the context of natural resource management" Ecology and Society.19 (1): 13.
Prediger, S. (2008). "Discontinuities for mental models - a source for difficulties with
the multiplication of fractions" Proceedings of ICME-11, Topic Study Group 10, Research and
Development of Number Systems and Arithmetic. (See also Prediger's references to Fischbein
1985 and Fischbein 1989, "Tacit models and mathematical reasoning".)
Robles-De-La-Torre, G. & Sekuler, R. (2004). "Numerically Estimating Internal Models of
Dynamic Virtual Objects". In: ACM Transactions on Applied Perception 1(2), pp. 102–117.
Sterman, John D. A Skeptic’s Guide to Computer Models, Massachusetts Institute of Technology

A mental model is an explanation of someone's thought process about how something works in
the real world. It is a representation of the surrounding world, the relationships between
its various parts and a person's intuitive perception about his or her own acts and their
consequences. Mental models can help shape behaviour and set an approach to solving problems
(similar to a personal algorithm) and doing tasks.

A mental model is a kind of internal symbol or representation of external reality,

hypothesized to play a major role in cognition, reasoning and decision-making. Kenneth Craik
suggested in 1943 that the mind constructs "small-scale models" of reality that it uses to
anticipate events.The image of the world around us, which we carry in our head, is just a
model. Nobody in his head imagines all the world, government or country. He has only selected
concepts, and relationships between them, and uses those to represent the real system
(Forrester, 1971).
In psychology, the term mental models is sometimes used to refer to mental representations
or mental simulation generally. At other times it is used to refer to 禮 Mental models and
reasoning and to the mental model theory of reasoning developed by Philip Johnson-Laird and
Ruth M.J. Byrne.

Historical Contexts
The theories we are going to consider here all have historical, cultural and religious
influences. Socrates (469-399 B.C.) and Aristotle (384-322 B.C.) were early "thinkers" who
wrote about the brain and tried to understand what influence the brain had on ‘the mind’
and how people behaved. Aristotle believed that the heart, not the brain, was important for
intelligence. Aristotle, building upon the work of the earlier philosophers and their studies
into mind, reasoning and thought, wrote the first known text in the history of psychology,
called Para Psyche, 'About the Mind.' In this landmark work, he laid out the first tenets
of the study of reasoning that would determine the direction of the history of psychology;
many of his proposals continue to influence modern psychologists. As much of the early Greek
studies was written down, it has been seen as the basis for modern thought into mental health,
however, other ancient civilisations also set out their ideas in different ways.

China
Hsün Tzu (ca. 312–230 BC) was a Chinese Confucian philosopher who lived during the Warring
States period and ...was compared with Aristotle as a naturalist who emphasised the
regularity and orderliness of nature. The Chinese described Yin and Yang (Links to an external
site.)Links to an external site. as both opposite and complementary forces. Yang is
associated with force, hardness, heat, dryness, and masculinity. Yin is associated with
weakness, softness, cold, moistness, and femininity. Equilibrium between Yin and Yang is
essential to physical and psychological health. In this way the Chinese opened the door to
physiological psychology with their belief that mental processes are central and are
associated with the physical body.

Egypt
Egyptian psychology was deeply intertwined with the polytheistic Egyptian religions and the
emphasis on immortality and life after death. Although the Egyptians appear to be the first
to describe the brain, they most often viewed the heart as the seat of mental life.

Other Eastern Philosophies

Thinkers in India, as reflected in the Vedas and the Upanishads (Links to an external
site.)Links to an external site., investigated knowledge and desire, among many other topics.
Hebrew philosophy (Links to an external site.)Links to an external site. and psychology must
be understood in light of radical monotheism: 'Humans have two sides, a biological,
self-serving side and a spiritual side capable of serving the larger community'. The Hebrews
had well-developed notions of mental disorders that were attributed to the anger of God or
human disobedience. Persia was the birthplace of the Zoroastrian religion (Links to an
external site.)Links to an external site. based on the teachings of Zarathustra and the holy
book Avesta. Zoroastrianism is the first monotheistic religion recorded in history;
flourished until the Muslim conquest of Persia. Human beings were the testing grounds of
good and evil, and mental and physical disorders were viewed as the work of the devil;
demonological diagnoses and treatments were common.

Major theories to understanding mental health & mental illness

There are a number of major or grand theories relating to understanding mental health:

Analytical/ Developmental theories: "Theories of development provide a framework for

thinking about human growth, development, and learning. If you have ever wondered about what
motivates human thought and behaviour, understanding these theories can provide useful
insight into individuals and society." (Cherry, 2014) Theorists: Freud, Jung, Eriksson,
Kohlberg.
Behavioural theories: "Behavioural psychology, also known as behaviourism, is a theory of
learning based upon the idea that all behaviours are acquired through conditioning. Advocated
by famous psychologists such as John B. Watson and B.F. Skinner, behavioral theories
dominated psychology during the early half of the twentieth century. Today, behavioural
techniques are still widely used in therapeutic settings to help clients learn new skills
and behaviours." (Cherry, 2014) Theorists: Watson, Skinner, Pavlov
Cognitive theories: "Cognitive psychology is the branch of psychology that studies mental
processes including how people think, perceive, remember, and learn. As part of the larger
field of cognitive science, this branch of psychology is related to other disciplines
including neuroscience, philosophy, and linguistics.." (Cherry, 2014) Theorists: Tolman,
Piaget, Chomsky
Social theories: "Social psychology looks at a wide range of social topics, including group
behavior, social perception, leadership, nonverbal behaviour, conformity, aggression, and
prejudice. It is important to note that social psychology is not just about looking at social
influences. Social perception and social interaction are also vital to understanding social
behaviour." (Cherry, 2014) Theorists: Bandura, Lewin, Festinger
There are lots of resources on the Internet for exploring these theories. One of the best
places to start is http://www.simplypsychology.org/ (Links to an external site.)Links to
an external site.. Before moving on to the modern views, we would like you to make sure you
have a good grasp of these 'Grand Theories'.

A modern view
Do the 'Grand Theories' discussed above fit with modern thinking? Can theories from a hundred
years ago really tell us what is and what is not mental health or illness? The following
two videos from the TED series offer quite different viewpoints.

1. The first talk is by Johnathan Haidt (a Social Psychologist), from 2008, "The moral roots
of liberals and conservatives":

2. The second video is by Thomas Insel, a neuroscientist and psychiatrist, and the Director
of the National Institute of Mental Health, from 2013, "Toward a new understanding of mental
illness"

Both of these speakers look at ways in which we make judgements about ourselves and about
others. Their views both contain elements of the 'Grand Theories' but are harnessing the
power of science (web science & semantics, and physiological imaging) to gather data and
to help us understand where the boundary is between mental health and mental illness.

tab.png References and Further Reading

Allport, G. W. (1985). The historical background of social psychology. In G. Lindzey, and
E. Aronson, (Eds.), Handbook of Social Psychology, 1, (3), 1-46

Carver, C.S. & Scheir, M.F. (2000). Perspectives on Personality. Needham Heights, MA: Allyn
& Bacon

Sternberg, R. (2003). Cognitive Psychology. Belmont, CA: Wadsworth

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-
HISTORICAL PERSPECTIVES ON THE THEORIES, DIAGNOSIS, AND TREATMENT OF MENTAL ILLNESS
Issue: BCMJ, vol. 59 , No. 2 , March 2017 , Pages 86-88 MDs To Be
By: Marc Jutras, BBA, UBC Medicine, Class of 2018
A walk through the drastic transformation of attitudes toward mental illness throughout
history.

A+ A-
Attitudes and views toward psychopathology in the medical and larger social community have
undergone drastic transformation throughout history, at times progressing through a rather
tortuous course, to eventually receive validation and scientific attention. Departing from
a simplistic view centred on supernatural causes, modern theories in the early 20th century
began to recognize mental disorders as unique disease entities, and two main theories of
psychodynamics and behaviorism emerged as potential explanations for their causes. With the
increasing acceptance of mental illness as a unique form of pathology, official diagnostic
classification systems were adopted, new avenues of research spawned, and modern approaches
to treatment incorporating pharmaacotherapy and psychotherapy were established. Although
much scientific progress has been made in the fields of diagnosing and treating mental illness,
at a societal level the recent psychiatric deinstitutionalization movement has been met with
mixed success, calling into question how to most effectively implement into clinical practice
the knowledge that has been gained over the previous centuries.

The prevailing views of early recorded history posited that mental illness was the product
of supernatural forces and demonic possession, and this often led to primitive treatment
practices such as trepanning in an effort to release the offending spirit.[1] Relatively
little in the way of improvements were achieved throughout the European Middle Ages, and
the oppressive sociopolitical climate saw many sufferers of mental illness being submitted
to physical restraint and solitary confinement in the asylums of the time.[2] It was not
until the late 19th and early 20th centuries that modern theories of psychopathology began
to emerge.

Around this time, two main theoretical approaches began to inform our understanding of mental
illness: the psychodynamic theory proposed by Austrian neurologist Sigmund Freud (1856–
1939), and the theory of behaviorism advanced by American psychologist John B. Watson (1878–
1958).[2] Freud’s theory of psychodynamics centred on the notion that mental illness was
the product of the interplay of unresolved unconscious motives, and should be treated through
various methods of open dialogue with the patient.[2] Behaviorism, on the other hand,
suggested that psychopathology was more closely related to the effects of behavioral
conditioning, and that treatment should focus on methods of adaptive reconditioning, using
the same principles of classical conditioning elucidated by the Russian physiologist Ivan
Pavlov (1849–1936).[2]

Against the backdrop of these broad theoretical frameworks, modern approaches to the
diagnosis and treatment of psychopathology began to emerge and, along with these, the need
to systematically categorize mental illness became apparent. In post–Second World War North
America a need for a formal classification system was recognized in order to provide more
efficient and targeted mental health services for veterans.[3] This led to the creation of
the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952,
which was largely drawn from the World Health Organization’s sixth edition of the
International Classification of Diseases (ICD-6).[3] Early editions of the DSM described
mental disorders in terms of “reactions,” postulating that such illnesses should be
classified with reference to antecedent socio-environmental and biological causative
factors.[3] However, in 1980 with the publication of the third edition, the DSM shifted its
focus and intentionally remained neutral on the potential etiological causes of the various
forms of mental illness. This position was maintained in subsequent editions, including the
current DSM-5, published in 2013.[3]

With theoretical frameworks and a classification system in place, the study and treatment
of mental illness began to expand significantly in the mid-20th century. Important
developments in this period laid the foundation for modern pharmacologic and
psychotherapeutic approaches aimed at addressing mental illness. From a pharmacological
perspective, the catecholamine hypothesis, published in the 1950s, was an influential
milestone although perhaps overly simplistic. Following research into the actions of drugs
like reserpine and monoamine oxidase inhibitors, the catecholamine hypothesis proposed that
depression and other affective disorders were likely caused by decreased levels of
catecholamines such as norepinephrine.[4]

The field of psychotherapy, with its early roots in Freud’s psychodynamic theory, also saw
new developments in this period. In particular, individuals such as American psychologist
Albert Ellis (1913–2007) and American psychiatrist Aaron T. Beck (b. 1921) began adopting
treatment approaches aimed at addressing the maladaptive cognitions and emotions underlying
mental disorders.[5,6] When combined with principles of behaviorism, this approach led to
the eventual development of cognitive-behavioral therapy (CBT), the current gold standard
psychotherapeutic approach in the treatment of anxiety disorders.[7] Taken together, the
catecholamine hypothesis and the development of CBT have had a substantial impact on the
modern treatment of depression and anxiety, the two disorders accounting for the highest
proportion of disability-adjusted life years among mental illnesses across the globe.[8]

In the latter half of the 20th century, various factors gave rise to the more recent
psychiatric deinstitutionalization movement in North America, including the advent of
antipsychotic drugs and the recognition that mental health expenses could be reduced by using
community-based outpatient settings in favor of inpatient care in psychiatric hospitals.[9]
In response to the recommendations of the Canadian Mental Health Association in the 1960s,[10]
deinstitutionalization was adopted in Canada and is ongoing today.[2] Unfortunately,
throughout Canada, the increase in community-based mental health services has not kept pace
with the closure of psychiatric hospitals,[11] contributing to problems of homelessness and
crime among many sufferers of mental illness.[2] The closure of Riverview Hospital, a mental
health facility in Coquitlam, serves as a poignant local example. Amid debates about how
to best deal with addiction and mental health problems in BC, Riverview Hospital is currently
slated to reopen by 2019,[12] and it will be interesting to see how other regions across
the country respond to the ongoing challenges of mental health care.

Western civilization’s relationship with mental illness has had a complex and varied history,
characterized by periods of relative scientific inertia and ostracism of those afflicted,
as well as periods of great theoretical insight and progressive thinking. Following the
abandonment of supernatural explanations/theories and with the emergence of logical thought
and experimental reasoning after the Middle Ages, the stage was set for a transition to a
humane method of treating mental illness. This shift led to the advent of modern theories
of mental illness, dedicated classification systems, as well as theoretical approaches to
treatment based on clinical evidence. Despite such progress, there remain ongoing public
health concerns with respect to effectively implementing the most appropriate model of mental
health care for society, and these will likely serve as major themes in the next chapter
of the history of mental illness.

Page 1 of 3 2011‐2012 Module Name: Theoretical Perspectives on Mental Health/Illness Module

Code: NU1P01 ECTS: 5 No. of Hours: 20 Term: Michaelmas Assessment Date: Week 16 Module Leader:
Jean Morrissey Lecturers: Jean Morrissey, Mike Watts, Brian Keogh Aims This module will
introduce students to a number of theoretical approaches, which offer ways of understanding
the nature of mental health and mental illness. The module will explore both historical and
contemporary discourses, with reference to bio/psychiatric, psychological, social,
political, spiritual and legal explanations of mental illness and distress. The module will
also explore literature on recovery, service user expertise, peer support and the role of
non statutory organisations. Emphasis will be placed on exploring how each lens of
understanding impacts on service users and families, with specific emphasis on: citizenship,
agency and social exclusion, service provision, professional roles, therapeutic approaches
to care and treatment, risk and power relationships. Learning Outcomes Following completion
of this module the student should be able to: • Discuss what is meant by the concept of mental
health. • Discuss the social, psychological and physical factors that negatively impact on
a person’s mental health • Describe the historical and contemporary explanations of mental
health and illness. • Compare and contrast the bio psychiatric/medical, psychological,
social and spiritual approaches to understanding mental health and illness. • Describe the
strengths and limitations of each approach as a way of understanding the cause, treatment,
and care of a person experiencing mental distress • Discuss the implications of each
explanation of mental illness/distress for the person’s agency and role in their own
recovery. • Discuss the principles underpinning a recovery approach to mental health service
provision and describe how a recovery approach would view the role of the person in their
own care. • Discuss the role and contribution of non statutory organisations and peer support
in mental health service provision and the care of people who are experiencing mental distress.
• Differentiate between the concepts of public stigma, self stigma and courtesy stigma, and
discuss the implications of labelling a person as mentally ill, in terms of citizenship
personhood and social inclusion. Page 2 of 3 2011‐2012 Indicative Content • Concept on Mental
health: World Health organisation’s definitions, continuum of mental health, stress and
mental health, coping and mental health. • Mental illness: theoretical approaches‐
historical theories, biomedical theories (genetic, biochemical, structural), biomedical
classifications (DSM and ICD), psychological theories (cognitive, psychoanalytic,
behavioural, stress cognitive vulnerability model), family theories (expressed emotion),
social (age, gender, social class, homelessness, education, substance misuse, violence and
abuse) spiritual and legal explanations. • Implications of each theory for the role of the
mental health nurse, therapeutic stance of mental health nurse, approach to risk, power,
agency and voice of the service user. • Recovery model, expertise by experience, and role
of hope, peer support and advocacy. • Impact of labelling, stigma and service providers
attitudes on personhood, citizenship, agency and social inclusion. Teaching and Learning
Activities • Lectures • Directed Learning Student Effort Hours • 100 Assessment Mode of
Assessment Unseen Examination Assessment Details 2 hours Answer 3 questions out of 5 Reading
List Essential Reading Farrelly, M. ‘Concepts of psychiatric/mental health nursing’ In:
Morrissey, J., B. Keogh & L. Doyle.(Eds) (2008) Psychiatric/Mental Health Nursing: An Irish
perspective, Gill & Macmillan, Dublin (Chapter 2) Watts, M. ‘Helping People make a Recovery
in the Community’, In: Morrissey, J., B. Keogh & L. Doyle. (Eds) (2008) Psychiatric/Mental
Health Nursing: An Irish perspective, Gill & Macmillan, Dublin (Chapter23 ) Norman, I; Ryrie,
I (2004) (eds) The Art and Science of Mental Health Nursing Buckingham: Open University Press.
(Chapters 1, 2 and 5) Page 3 of 3 2011‐2012 Pilgrim D. Rogers A. (2005) A Sociology of Mental
Health and Illness. Maidenhead: Open University Press. (Chapters 1‐5) Repper, J Perkins
R (2003) Social Inclusion and Recovery; A Model for Mental Health Practice Edinburgh:
Balliere Tindall Recommended Reading Bentall, R (2003) Madness Explained: Psychosis and
Human Nature, London: Penguin Books Cleary, A., Treacy, M. (eds) (1997) The Sociology of
Health and Illness in Ireland, Dublin: University College Dublin Press. Davidson, L (2003)
Living Outside Mental Illness: Qualitative Studies of Recovery in Schizophrenia. New York,
London: New York University Press Grove, B; Secker, J; Seebohm, P (2005) New Thinking about
Mental Health and Employment. Oxford: Radcliffe Publishing. Shorter, E (1997) A History of
Psychiatry: From the Era of the Asylum to the Age of Prozac New York: John Wiley & Sons,
Inc Tyrer, P., & Steinberg, D. (1996) Models for mental disorder: Conceptual models in
psychiatry. (3rd ed.). Chichester: John Wiley.

BLOG: Why Mental Health is ImportantMental illnesses affect 19% of the adult population,
46% of teenagers and 13% of children each year. People struggling with their mental health
may be in your family, live next door, teach your children, work in the next cubicle or sit
in the same church pew. However, only half of those affected receive treatment, often because
of the stigma attached to mental health. Untreated, mental illness can contribute to higher
medical expenses, poorer performance at school and work, fewer employment opportunities and
increased risk of suicide. What Exactly is a Mental Illness A mental illness is a physical
illness of the brain that causes disturbances in thinking, behavior, energy or emotion that
make it difficult to cope with the ordinary demands of life. Research is starting to uncover
the complicated causes of these diseases which can include genetics, brain chemistry, brain
structure, experiencing trauma and/or having another medical condition, like heart disease.
The two most common mental health conditions are: Anxiety Disorders – More than 18% of adults
each year struggle with some type of anxiety disorder, including post-traumatic stress
disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder (panic attacks),
generalized anxiety disorder and specific phobias. Mood Disorders – Mood disorders, such
as depression and bipolar depression, affect nearly 10% of adults each year and are
characterized by difficulties in regulating one’s mood. What You Can Do to Help Mental Health
Awareness 2016Although the general perception of mental illness has improved over the past
decades, studies show that stigma against mental illness is still powerful, largely due to
media stereotypes and lack of education, and that people tend to attach negative stigmas
to mental health conditions at a far higher rate than to other diseases and disabilities,
such as cancer, diabetes or heart disease. Stigma affects not only the number seeking
treatment, but also the number of resources available for proper treatment. Stigma and
misinformation can feel like overwhelming obstacles for someone who is struggling with a
mental health condition. Here a few powerful things you can do to help: Showing individuals
respect and acceptance removes a significant barrier to successfully coping with their
illness. Having people see you as an individual and not as your illness can make the biggest
difference for someone who is struggling with their mental health. Advocating within our
circles of influence helps ensure these individuals have the same rights and opportunities
as other members of your church, school and community. Learning more about mental health
allows us to provide helpful support to those affected in our families and communities.
Resources Great sources for mental health news and information include: National Institute
of Mental Health Mental Health America Pine Rest Mental Health Resources Jean HolthausJean
Holthaus, LISW, MSW, is a Licensed Independent Social Worker and clinic manager at the Pine
Rest Pella Clinic. She earned a BA in Elementary Education from the University of Northern
Iowa and a Masters of Social Work from the University of Iowa in 1995.

Mental health strengthens and supports our ability to: have healthy relationships make good
life choices maintain physical health and well-being handle the natural ups and downs of
life discover and grow toward our potential Mental Health Treatment Reduces Medical Costs
Many research studies have shown that when people receive appropriate mental health care,
their use of medical services declines. For example, one study of people with anxiety
disorders showed that after psychological treatment, the number of medical visits decreased
by 90%, laboratory costs decreased by 50%, and overall treatment costs dropped by 35%. Other
studies have shown that people with untreated mental health problems visit a medical doctor
twice as often as people who receive mental health care. Excessive anxiety and stress can
contribute to physical problems such as heart disease, ulcers, and colitis. Anxiety and
stress can also reduce the strength of the immune system, making people more vulnerable to
conditions ranging from the common cold to cancer. Psychological problems also increase the
likelihood that people will make poor behavioral choices which can contribute to medical
problems. Smoking, excessive alcohol or drug use, poor eating habits, and reckless behavior
can all result in severe physical problems and the need for medical services.

The importance of relationships in mental health care: A qualitative study of service users'
experiences of psychiatric hospital admission in the UK
Helen GilburtEmail author, Diana Rose and Mike Slade
BMC Health Services Research20088:92
https://doi.org/10.1186/1472-6963-8-92 漏 Gilburt et al; licensee BioMed Central Ltd. 2008
Received: 17 December 2007Accepted: 25 April 2008Published: 25 April 2008
Open Peer Review reports
Abstract
Background
While a number of studies have looked at life on service users' experiences of life on
psychiatric wards, no research exists that have approached these experiences from the user
perspective since the introduction of community care.

Methods
This user-led study uses a participatory approach to develop an understanding of the
processes and themes which define the user experience of hospitalisation. Nineteen service
users who had all had inpatient stays in psychiatric hospitals in London were interviewed
in the community.

Results
Relationships formed the core of service users' experiences. Three further codes, treatment,
freedom and environment defined the role of hospital and its physical aspects. Themes of
communication, safety, trust, coercion, and cultural competency contributed to the concept
of relationships.

Conclusion
Relationships with an individual which comprised effective communication, cultural
sensitivity, and the absence of coercion resulted in that person being attributed with a
sense of trust. This resulted in the patient experiencing the hospital as a place of safety
in terms of risk from other patients and staff. Barriers to positive relationships included
ineffective and negative communication, a lack of trust, a lack of safety in terms of staff
as ineffective in preventing violence, and as perpetrators themselves, and the use of
coercion by staff. This unique perspective both acts as a source of triangulation with
previous studies and highlights the importance of the therapeutic relationship in providing
a safe and therapeutic milieu for the treatment of people with acute mental health problems.

Keywords
Service User
Patient Experience
Psychiatric Hospital
Therapeutic Relationship
Cultural Awareness
Background
The patient experience is increasingly being recognised as an important factor in developing
and providing excellence in healthcare. In the UK, improving the patient experience is
declared to be central to everything the NHS does and the newly formed 'Improving the Patient
Experience' initiative, a collaborative project across the whole National Health Service,
is recognition of this [1].

A review of studies focusing on what is known about psychiatric in-patient care revealed
five methodological approaches to investigating the experiences of patients in acute
admission wards [2]. These included participant observation, discourse/conversation
analysis, in-depth or semi-structured interviews with patients, quantitative surveys of
patients, and 'snapshot' observational methods. Surveys have sought patient ratings on broad
sets of topics including general satisfaction, physical environment, staff-patient
relationships, information, treatment, restrictiveness, autonomy, individualisation, and
control and compulsory admission [3, 4, 5, 6]. In addition, qualitative interviews have
largely focused on making sense of specific themes such as violence, involuntary treatment,
coercion, care, admission, treatment, restraint, seclusion, observation, mixed sex units,
environment and rules, daily life and relationships with staff. However a number of authors
have identified difficulties with the current knowledge of the patient experience of
inpatient psychiatric services. The variables on which survey measures are based have been
criticised for their lack of theoretical underpinning [7], and both these variables and the
themes identified for qualitative investigation are largely clinician-derived [8].
Divisions in the views of patients and professionals in terms of what variables and themes
are important mean that the resulting studies may be a poor representation of the user
perspective [9, 10]. Quirk and Lelliot [2] also concluded that, of the research they reviewed,
the emphasis was very much on clinical practice and the worlds of professionals and that
there was a real need for in-depth interview studies involving patients to understand the
meaning of in-patient care to these people.

Participatory research aims to bring into the foreground the lived experience and indigenous
knowledge of participants. Participatory approaches invite the participation of
stakeholders in research and in doing so act to recognise the role of power in the research
process and challenge this. In emancipatory research, participants control all aspects of
the research process as opposed to simply participating. The roots of emancipatory research
lie in feminist theory [11]. Like that of feminist, black, and other established new paradigm
research fields, emancipatory research maintains that a different view may be obtained when
the researched become the researchers. Emancipatory research in the mental health field has
taken the form of user-led research. The benefits of user-led research are that the work
done is relevant to the concerns of service users [12], the reciprocal relationship between
interviewer and interviewee puts both on a more equal footing [13], aids the ability to
achieve real empathy [14] and can elicit the collection of data not otherwise accessible
[12]. During data analysis the researchers background sensitises them to themes and concepts
that may otherwise not be apparent. Finally, revisiting the subject of patients' experiences
from the unique perspective of a user-led study serves not just as a source of new data but
also allows triangulation with previous research.

The aim of this paper is to explore the experiences of admission to acute psychiatric hospital
from the perspective of services users. Key themes are identified and triangulated with
previous research to confirm and expand our current understanding of the impact and
consequences of mental health care in psychiatric hospital.

Method
Design
As a user-led study a participatory research approach was used. Both HG and DR are service
users with experience of admission to psychiatric hospitals. Both researchers were involved
in the design and analysis of the research study. The interviews were undertaken by HG.
Particular notice was taken of the power imbalances involved in the research process and
efforts were made wherever possible to empower participants. The data was analysed using
thematic analysis. One of the benefits of thematic analysis is its flexibility and
independence of theory and epistemology which can potentially provide a rich and detailed,
yet complex account of data. The unique user-focus of this study resulted in the use of an
inductive approach to the identification of themes where the themes are strongly linked with
the data themselves. Consequently the relevant literature is only reviewed after the analysis
is completed [15].

Participants
A total of 19 service users who had each experienced admission to a psychiatric hospital
in England were recruited. Glaser [16] suggests that in the initial stages of a study,
researchers should begin by talking to the most knowledgeable people to get a line on
relevancies and immerse oneself in a rich supply of data. Participants were identified
through volunteer sampling because there were no data to direct what further information
should be sought and explored. Two sampling strategies were used. Mental health resource
centres were identified as suitable recruitment sites as Catty and Burns [17] reported that
many clients of such services had used, and continued to use, inpatient services. In addition
an advert was placed in a local mental health charity newsletter to reach a larger audience
including mental health service users who were working and unlikely to be using mental health
resource centres. The advert described the study and the researchers contact number for more
information. This study formed part of a larger study into residential alternatives to
traditional psychiatric hospitals and as a consequence, resource centres and participants
were contacted in the London boroughs of Haringey, Croydon, Havering, Camden, Islington and
Harrow in which residential alternative services were also located. Following initial
contact with each resource centre, the researcher attended a community meeting at each of
the services to introduce the study to service users and answer any questions. The researcher
returned to each service on an arranged date to conduct the interviews. Prior to each
interview, each participant was given an information sheet and their written consent was
sought. Seventeen participants were recruited from four mental health resource centres and
a further two participants through the newsletter.

Ten of the participants were men and nine were women; 13 participants were white British,
one was white European, three were Black British and two were Asian British. The majority
were between the ages of 25 and 60, while three were above the age of 60. All but two adults
of working age were unemployed. Collectively participants had had inpatient stays in over
10 different hospitals in England and comprised both service users who had had a number of
admissions over several years, and those who had more recently come into contact with
inpatient services for the first time.

Data collection
We initially conducted a focus group of ten people at a mental health resource centre. A
further nine participants took part in face-to-face interviews. While participatory
approaches focus on the role of power dynamics in the research process, Hoffman [18] argues
that during interviews both interviewers and interviewees wield these powers at different
times and in various ways. As such the process of reflexivity becomes crucial for the
interviewer to recognise the power dynamics through the research process and work towards
the empowerment of participants. As an academic researcher and initiator of the contact,
the interviewer held a certain amount of power. A number of strategies were employed in order
to help move the researcher and participants to a more equal sharing of power. Interviews
were scheduled at a time and location of the participant's choice and an open and unstructured
interview format was used. Each interview opened with the request "Tell me about your
experiences of being an inpatient," allowing participants to determine the direction of the
conversation. The researcher assumed an open stance towards the participants as well as
sharing personal details and answering questions both during the interview and afterwards.
At the conclusion of each interview participants were paid a nominal sum for their time and
contribution.

After each interview the researcher wrote memos of personal reflections and theoretical
insights. Data collection and analysis were iterative with each step of analysis. In each
subsequent interview, the researchers' understanding of the themes arising through coding
and reflection was shared with participants to seek further understanding of the themes for
explanation in later interviews.

Analysis All interviews were audio-taped and transcribed verbatim by the first author helping
familiarise the researcher with the data. Responses were analysed using the inductive
thematic analysis procedure described by Hayes [19]. First, the data was read carefully to
identify meaningful units of text relevant to the research topic. Second, units of text
detailing the same issue were grouped together in analytic categories and given provisional
definitions. The same unit of text could be included in more than one category. Third, the
data were systematically reviewed to ensure that a name, definition, and exhaustive set of
data to support each category were identified. The inductive thematic analysis resulted in
27 categories, which were grouped into 8 key themes. During the entire coding process, memo
writing was used both as an analytical tool to record concepts, themes and more abstract
thinking about the data, but was also used as a means of reflection, to record the researcher's
own beliefs and experiences. Both the data and memos were shared with authors' research
supervisor DR and discussed until consensus was reached. Results One of the most important
findings of the current study was that when participants talked about their experiences of
hospital, they did so largely within the context of the people that they had encountered
during their admission. Five out of the eight themes related to relationships, these included
communication, coercion, safety, trust, and culture and race. One theme, treatment,
highlighted the role of admission to hospital. Two further themes are structural, providing
an understanding of the environment of hospital and include the themes, environment and
freedom. The role of communication Communication was highlighted by all participants and
constituted the greatest number of coded sections, constituting a third of all coded sections.
This illustrates its importance to service users. Communication comprised three specific
activities, listening, talking and understanding. In order for communication to take place
the participants must be approachable and/or initiate contact. "As soon as you come they
can see that you are angry. Then someone will say, sit down, let's talk about it, make a
cup of tea." Obstacles to communication included unavailability. "The staff work hard at
trying to stay away from the clients was my opinion. Be in their office as much as they could."
Listening was rated highly by service users. The ability to listen was described as a
characteristic of being human and service users who had the experience of being listened
to described feeling respected. Conversely, one service user rated a whole service negatively
because he felt the staff did not listen to him. Listeners who were open, non-judgemental
and not patronising were valued. "...they have their own agenda about what I ought to do
and the way I ought to be, rather than let me talk about my problems. I need someone to listen
to me and I can't get them to listen to me." "I took away from that was the feeling, the
humanness of everybody, the commitment of everybody and I was just so moved by the willingness
of so many people to sit and listen to whatever it is however horrific it might be or however
banal it might be they were willing to listen to it all and not patronise me." The process
of talking was by far the most prominent aspect of communication and represented over half
of the codes linked to communication. It was identified as important by all participants.
Talking was described as therapeutic, but only if the service user was listened to and
understood. Service users who were understood valued relevant advice and information.
Interviewer: "What did you like about the staff?" Service user: "The actual nurses, I think
they sort of, understood" Thirteen people identified numerous instances of a lack of, or
poor communication, between service users and staff. In contrast there were no such negative
references to communication between service users. One of the key factors in being able to
communicate with other users was the shared experience. "And when I was there I met patients
that I could sort of talk about things between us and she'd know what I meant." There is
an overlap between the topics communication and coercion. Positive experiences of
communication led to a person feeling supported and cared for, however, coercive
communication, such as the use of threats, was experienced entirely negatively. Coercion
Coercive experiences were reported by all of the service users interviewed. Objective
coercion, such as involuntary commitment and treatment, was often negatively reported, but
the coercion of being detained was not attributed to the legal process involved but rather
to coercive events that service users were subject to as a consequence of detention. Such
events included restriction of freedom and compulsory treatment. "See the first time I ever
went in there I think I was on a section actually and it felt horrible. It felt horrible
because I was locked away for so many days and I couldn't go out and be free." Four men and
one woman described being restrained. All were involuntarily detained when the restraint
occurred. All counts of restraint were accompanied with forcible medication. Restraint was
described as a form of assault and in one case as leading to physical injury. "I wasn't
restrained, I was attacked." "They wanted to tear me to pieces and I have arthritis of the
shoulder to prove it." Perceived coercion was reported by both compulsorily and voluntarily
admitted patients. It followed the form of threats of non-physical force or of consequences
resulting from disobeying staff wishes. Perceived coercion was described by service users
as being "hypnotised" and "brainwashed" and reactions to perceived coercion were referred
to by two people as "playing the game". The most common threat experienced by voluntary
patients was of being detained. This was reportedly used to coerce patients into hospital
on a voluntary basis, and once admitted into remaining in hospital or receiving unwanted
treatment. "First of all I didn't want to go in and my GP at the time said either you go
in or I section you." "...and my psychiatrist said if you don't take your tablets I will
section you and give you ECT under section." The use of non-physical force also represents
a form of perceived coercion. "I was forced to take medication that was causing me a lot
of discomfort." A final category of coercive experiences includes reports in which a clear
abuse of power and trust is taking place with little justification. Three people report such
incidences. One incident described a staff decision not to treat a patient in considerable
distress. "There was a nurse who I witnessed saying to him, while you were in this catatonic
state and before you got ECT you weren't aware of this but one of the other nurses pulled
you off the ground and was taunting you, pulled you off the seat and was taunting you, breaking
up your cigarettes in front of you to try and get you to react." There was a link between
the codes for "coercion" and "safety". Descriptions of perceived coercion that were
associated with feelings of a lack of safety, rather than actual coercive practices such
as restraint. "Knowing that if I tried to leave I would just get sectioned. So it was a
terrifying place, position to be in." Safety from self, safety from others All participants
talked about safety. An expectation of hospital was that it would be safe, with service users
seeking safety both from themselves and from staff or other patients. "So I felt, you know,
being in hospital was one way of keeping me safe." Safety in hospital was always spoken about
with reference to other people. Social contact could instil a sense of safety in some people,
but in others contributed to a lack of safety, and its perception depended on the nature
of the contact. "I need people around me so I don't go and stab myself or do anything really
stupid." "The first thing I got when I was up there was threatened by a bloke." A lack of
safety was associated with ward-based violence, and the feeling of fear. Four participants
reported acts of violence and aggression perpetrated by themselves towards members of staff
and inpatients, while another four describe incidences of being subjected, or witnessing
other patients being subjected, to violence by both staff and other patients. Experiences
of violence were always accompanied with a feeling of fear. All but three people described
feeling fearful while in hospital. Fear was described as a contributing factor to
perpetrating violent acts and as a consequence of experiencing violence.

The Mental Management System has played a big part in 2016 being a pivotal year for me as
a competitor in K9 Nose Work and in business. I know some of you have already started using
this system and I am excited to see what 2017 holds. Below is an article by Heather Sumlin
from Mental Management System...what do your circles look like. .....Nancy Reyes this was
taken from the mental management dog handling newsletter. If you have any questions, email
Heather Sumlin at heather@mentalmanagement.com As I was preparing for this newsletter I
realized I am uncertain of where all of the readers are in their understanding of Mental
Management. Most of you have probably at least read “With Winning in Mind” which lays a
good foundation for what we teach. However, “With Winning in Mind” is not specific to your
sport and most of the examples are of sports with repetitive action like rifle shooting,
golf or bowling. Handlers have a longer action phase than a golf shot and there is a need
to control the mind and trust your training during a longer period of time. Plus the handler
has an added variable, their dog. So for this issue I will give a quick breakdown of the
mental processes for handlers. There are three mental processes that control performance
no matter the activity. The Conscious Mind is your thoughts, which need to be controlled
by you and not by your environment. We are almost always thinking and if we can decide in
advance the optimum way to think before, during and after the action we can improve
consistency. The Subconscious Mind is your skills, which are built in training – the quality
of your training enhances the quality of your skills. Every time you take a class from an
instructor, attend a seminar, train from home or compete in a trial you have the opportunity
to build Subconsious skill. Self-Image is the most important mental process because without
a strong Self-Image you cannot reach your potential under pressure. We will perform to the
size of our Self-Image not our skill level in most cases. Your Self-Image is your habits
and attitudes – it is what makes you act like you. It is your belief in your ability as
a handler, a competitor, a teammate and a trainer. Building Self-Image takes intentional
effort with focus on changing habits and attitudes. It is not easy to change Self-Image but
it is possible and vital to success. If your Self-Image is equal to your skill level and
your Conscious Mind is focused in the right place you have a great chance to reach your
potential under pressure. In our system we use circles to represent each mental process and
our goal is to be balanced in our circles. Quick example of handlers who may be out of balance:
The Beginner will have a larger Conscious circle because they have not developed skill or
confidence in their handling. They are learning which is done Consciously first. It will
take time through repetition to gain the skills needed to advance in the sport. The Frustrated
Expert is someone who has been working on building skills and focus but hasn’t spent enough
time building Self-Image. This handler is out of balance because their Self-Image is much
smaller and even if they are focused and prepared for a competition, if they do not have
the confidence in their ability to succeed under pressure due to having a small Self-Image
circle they will most likely make mistakes in their runs that lead to a performance less
than their potential. The Unfocused is a handler who may have been in balance on the way
to the trial and then something or someone pulls their focus. Maybe they realized certain
people were present or they hear negative comments from others and their thoughts become
taken hostage by their environment. Another example of unfocused is the handler who thinks
about the importance of the Q and are outcome driven prior to a run instead of focusing on
the processes of executing their plan. There are many ways to be out of balance, these are
just a few examples. I recommend you take some time to think about if you are in balance
or not. If not, why not? You may have different set of circles for different circumstances,
obstacles, events, dogs (if you have multiple dogs – you may be in balance more with one
than the other), training vs competition, etc. Your goal is to find the mental processes
that need to be built and work on bringing those up to the same level as the others. Handlers
often times struggle because they spend time building the skill level, Self-Image and
Conscious Mind of their dog more than they spend building themselves. I believe you must
build your dog’s circles but you must be focused on yourself as a handler to reach your
true potential. Most of this will be review for many of you who have our products and have
attended training. Send me an email with questions you would like for me to answer is a future
issue. I am happy to help in any way I can. Heather Sumlin

Around 20% of the world's children and adolescents have mental disorders or problems About
half of mental disorders begin before the age of 14. Similar types of disorders are being
reported across cultures. Neuropsychiatric disorders are among the leading causes of
worldwide disability in young people. Yet, regions of the world with the highest percentage
of population under the age of 19 have the poorest level of mental health resources. Most
low- and middle-income countries have only one child psychiatrist for every 1 to 4 million
people.

About 800 000 people commit suicide every year Over 800 000 people die due to suicide every
year and suicide is the second leading cause of death in 15-29-year-olds. There are
indications that for each adult who died of suicide there may have been more than 20 others
attempting suicide. 75% of suicides occur in low- and middle-income countries. Mental
disorders and harmful use of alcohol contribute to many suicides around the world. Early
identification and effective management are key to ensuring that people receive the care
they need.
Stigma and discrimination against patients and families prevent people from seeking mental
health care Misunderstanding and stigma surrounding mental ill health are widespread.
Despite the existence of effective treatments for mental disorders, there is a belief that
they are untreatable or that people with mental disorders are difficult, not intelligent,
or incapable of making decisions. This stigma can lead to abuse, rejection and isolation
and exclude people from health care or support. Within the health system, people are too
often treated in institutions which resemble human warehouses rather than places of healing.

Human rights violations of people with mental and psychosocial disability are routinely
reported in most countries These include physical restraint, seclusion and denial of basic
needs and privacy. Few countries have a legal framework that adequately protects the rights
of people with mental disorders.

Globally, there is huge inequity in the distribution of skilled human resources for mental
health Shortages of psychiatrists, psychiatric nurses, psychologists and social workers are
among the main barriers to providing treatment and care in low- and middle-income countries.
Low-income countries have 0.05 psychiatrists and 0.42 nurses per 100 000 people. The rate
of psychiatrists in high income countries is 170 times greater and for nurses is 70 times
greater.

There are 5 key barriers to increasing mental health services availability In order to
increase the availability of mental health services, there are 5 key barriers that need to
be overcome: the absence of mental health from the public health agenda and the implications
for funding; the current organization of mental health services; lack of integration within
primary care; inadequate human resources for mental health; and lack of public mental health
leadership.

Financial resources to increase services are relatively modest Governments, donors and
groups representing mental health service users and their families need to work together
to increase mental health services, especially in low- and middle-income countries. The
financial resources needed are relatively modest: US$ 2 per capita per year in low-income
countries and US$ 3-4 in lower middle-income countries