Instructional Module in NCM 117a (Care of Clients with Maladaptive Patterns of Behavior, Acute and

Chronic) |1

CHAPTER I. CONCEPTS OF MENTAL HEALTH AND MENTAL ILLNESS

As you embark on your course of studying how to take care of clients with
maladaptive patterns of behavior, you may be experiencing a myriad of thoughts and
feelings, including excitement, uncertainties, and anxiety. This nursing field may appear
mysterious or unfamiliar to most of you, evoking difficulty imagining what learning
experiences will be like or what nurses do in this field. This chapter provides you with the
fundamental knowledge that prepares you to develop competencies in delivering nursing
care to clients with maladaptive patterns of behavior.

Specifically, the significant concepts that you need to learn in this chapter include
the following:

Lesson 1 - State of Mental Health and Mental Illness in the Country and the World
Lesson 2 - Psychobiologic Bases of Behavior
Lesson 3 - Therapeutic Models and its Relevance to Nursing Practice
Lesson 4 - Understanding Stress
Lesson 5 - Diagnosis - DSM V
Lesson 6 - Psychopathology, Etiology, and Psychodynamics of Mental Disorders

LESSON 1: STATE OF MENTAL HEALTH AND MENTAL ILLNESS IN THE COUNTRY AND THE
WORLD

INTRODUCTION OF THE LESSON

AND PRESENTATION OF OUTCOMES

This lesson presents vital information about the state of mental health and mental
illness globally and in the country. Likewise, this lesson covers the mental health care
delivery system that seeks to minimize the burdens of mental disorders.

LEARNING OUTCOMES FOR THIS LESSON

At the end of this lesson, you must have:

1. described the state of mental health and mental illness in the country and
worldwide; and
2. described mental health care delivery system addressing the burdens of
mental disorders.

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WARM-UP ACTIVITY. Based on your knowledge and observation,

how prevalent are mental disorders in your locality? What is your
observation of how persons with mental illnesses are taken care of?

CENTRAL ACTIVITIES

This part of the lesson includes two learning inputs and two activities. You need to
accomplish the activities and submit them in the designated folders of this lesson.

LEARNING INPUT 1.

State of Mental Health and Mental Illness in the World

Estimates in 2017 show that 792 million individuals lived with a mental health
disorder globally. This number indicates that about one in ten individuals has a mental
disorder worldwide (10.7%). Mental disorders are of many types and presented differently.
Generally, persons with mental disorders manifest abnormal thoughts, perceptions,
emotions, behavior, and relationships with other individuals. The table below summarizes
the number of individuals afflicted with mental disorders, including substance use disorders,
in 2017 worldwide (Ritchie & Roser, 2018).

Table 1. Number of individuals with mental disorders globally in 2017.

Mental Disorder Number of Individuals with the Disorder
(2017)
Any mental health disorder 792 million
Depression 264 million
Anxiety disorders 284 million
Bipolar disorder 46 million
Eating disorders(clinical anorexia & bulimia) 16 million
Schizophrenia 20 million
Any mental or substance use disorder 970 million
Alcohol use disorder 107 million
Drug use disorder (excluding alcohol) 71 million

What makes people at risk of mental disorders? Individual characteristics (e.g.,

capability to manage thoughts, emotions, behaviors, and interactions with others) are
essential determinants of mental health and mental disorders. Likewise, genetics, nutrition,
stress, perinatal infections, and environmental hazard exposure put individuals at risk of
mental disorders. Additionally, social, cultural, economic, political, and environmental
factors (e.g., national policies, social protection, living standards, working conditions, and

Chapter 1 Lesson 1: State of Mental Health and Mental Illness in the Country and the World
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community support) are also considered determinants of mental health and mental
disorders. With these contributory factors, the burden of mental disorders continuously
grows, affecting all countries’ health, human rights, social, and economic aspects (World
Health Organization, 2019).

Despite the significant impacts of mental disorders, health systems have not
adequately responded to minimize the burden of mental disorders. Consequently, a wide
gap between the treatment needs and service delivery exists globally. Specifically, 76% to
85% of individuals with mental disorders do not receive treatment in low-and middle-
income countries of the world. Besides, many individuals treated for their condition receive
low care quality (GBD 2017 Disease and Injury Incidence and Prevalence Collaborators,
2018). Wainberg et al. (2017) corroborated these findings asserting that the contributory
factors to the present mental health treatment gap include:
 stigma (a barrier to mental health service uptake),
 human resource shortages,
 fragmented service delivery models, and
 lack of research capacity for implementation and policy change.

As to human resources, only one percent of the world’s health workforce works in
mental health. Of those one percent, 43% are nurses, 8% are psychiatrists, 7% are
psychologists, 3% are social workers, 1.5% are occupational therapists, and the remaining
33% include other health workers. The global percentage of mental health prevention and
promotion programs based on type include mental health awareness/anti-stigma (55%),
maternal mental health promotion (2%), school-based mental health promotion (11%),
parental/family mental health promotion (4%), violence prevention: women, child abuse
(5%), workplace mental health promotion (9%) and suicide prevention (8%). Regarding
service contact by individuals with mental disorders, 90% is through out-patients services
and only 10% via inpatient services. Aside from these, two-thirds of WHO member states
have a stand-alone mental health policy or plan, and only half have a stand-alone mental
health law. In many countries, however, policies, plans, and laws are not entirely congruent
with international human rights covenants. Also, people with mental disorders and family
members are not allowed in policy/plan/law development (WHO, 2015).

Significantly, the World Health Organization responded to minimize the burden of

mental disorders over the years (WHO, 2019). In 2013, the World Health Assembly endorsed
the WHO’s Health Action Plan 2013-2020. The plan recognized mental health’s vital role in
attaining health for all people with its four main objectives:
 more effective leadership and governance for mental health;
 the provision of comprehensive, integrated mental health and social care
services in community-based settings;
 the implementation of strategies for promotion and prevention; and
 strengthened information systems, evidence, and research.

Furthermore, in 2008, WHO launched its Mental Health Gap Action Programme
(mhGAP). It utilizes evidence-based technical guidance, tools, and training packages to
expand countries’ services, especially in resource-poor settings. It also focuses on a

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prioritized set of conditions, directing capacity building towards non-specialized health-care

providers in an integrated approach that promotes mental health at all levels of care.

Moreover, in 2016, mental health was endorsed by World Bank as a global

development priority, and the United Nation’s development agenda reflected in the
Sustainable Development Goals explicitly included mental health. These two significant
events provide opportunities for all sectors to increase mental health funding, promote
research, and strengthen capacity-building programs.

ACTIVITY 1. Based on what you have learned so far, what factors are
associated with the gap between the treatment needs of persons
with mental disorders and mental health care provision worldwide?

Submit your output for this activity in the submission folder 1 of this lesson.

LEARNING INPUT 2.

State of Mental Health and Mental Illness in the Philippines

The Philippines, categorized as a lower-middle-income country, is significantly

burdened by mental disorders. Although there is a dearth of epidemiological evidence on
mental disorders, some crucial data exist. For instance, the Philippines Statistics Authority
(2010, as cited in Lally, 2019) identified that of the 1.4 million Filipinos with disabilities, 14%
have a mental disorder. According to the National Statistics Office, mental illness is the third
most prevalent form of morbidity. Recent findings generated by the Philippine Health
Information System on Mental Health through a survey of 14 public and private hospitals
from 2014 to 2016 reveal that 42% of the 2562 surveyed patients received treatment for
schizophrenia (Lally et al., 2019). An increase in the country’s estimated suicide incidence
(from 0.23 to 3.59 per 100 000 in males and from 0.12 to 1.09 per 100 000 in females) was
also noted between 1984 and 2005 (Redaniel et al., 2011). In 2016, an overall suicide rate of
3.2/100 000, with a higher rate in males (4.3/100 000) than females (2.0/100 000), was
identified (WHO, 2018).

How does the country address the burden of mental disorders? The Philippine
Mental Health Act (Republic Act no. 11036) was signed into law on 21 June 2018. This law
seeks to establish access to comprehensive and integrated mental health services and
protects the rights of individuals with mental disorders and their family members (Senate
and House of Representatives of the Philippines, 2017).

In the country, hospitals provide the majority of mental healthcare services with
underdeveloped community mental health services. It was estimated that there are 1.08
mental health beds in general hospitals and 4.95 beds in psychiatric hospitals per 100 000 of
the Philippine population. Also, there are 46 outpatient facilities (0.05/100 000 population)

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and four community residential facilities (0.02/100 000) (WHO, 2014). Only two tertiary care
psychiatric hospitals exist, the National Center for Mental Health in Mandaluyong City,
Metro Manila (4200 beds), and the Mariveles Mental Hospital in Bataan, Luzon (500 beds).
Affiliated with the National Center for Mental Health are 12 smaller satellite hospitals
located all over the country. Although forensic beds are located at the National Center for
Mental Health, there are no hospitals for forensic cases. Mental health facilities also face
overcrowding, poorly functioning units, chronic manpower shortages (psychiatrists,
psychologists, nurses), and funding constraints, especially peripheral facilities (Lally et al.,
2019).

Furthermore, data indicate that there is only one doctor for every 80 000 Filipinos
(WHO & Department of Health, 2012). Nationally, there are about 500 psychiatrists in
practice. The ratio of mental health workers per population in the Philippines is low (2–3 per
100 000 population) (WHO & Department of Health, 2006). Data also shows that there are
0.52 psychiatrists (Isaac et al., 2018) and 0.07 psychologists per 100 000 of the population,
and 0.49 mental health nurses per 100 000 of the population (WHO, 2014). These data
reflect a severe shortage of mental health specialists in the country since WHO recommends
a global target of 10 psychiatrists per 100 000 population. Additionally, most psychiatrists
have private practices and are primarily based in the urban areas, particularly in Metro
Manila (Lally et al., 2019).

Moreover, the prevailing economic conditions and the inaccessibility of mental

health services limit access to mental health care. Besides, perceived stigma is a barrier to
help-seeking behavior among Filipinos (Tuliao & Velasquez, 2014). Additionally, a national
Department of Health Medication Access Program for Mental Health carries a central list of
essential drugs available at all service levels. However, funding issues limit client access,
especially to newer medications (Lally et al., 2019).

The preceding discussions reflect the existence of gaps in the provision of mental
health services in the country. Although the Mental Health Law provides a framework for
providing comprehensive and integrated mental health care, factors such as accessibility
and affordability of mental health services remain challenging health care delivery.

ACTIVITY 2. Considering what you have learned at this point,

what factors are associated with the gap between the treatment
needs of persons with mental disorders and mental health care
provision in the country?

When you are finished, upload your work in the submission folder 2 of
this lesson.

Chapter 1 Lesson 1: State of Mental Health and Mental Illness in the Country and the World
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Chronic) |6

WRAP-UP ACTIVITY. Considering what you have learned in this lesson,

what is your impression of the state of mental health and mental illness
(worldwide and in the country) and the mental health care delivery system
addressing the burdens of mental disorders in the Philippines?

This ends our discussion in lesson 1. Check your understanding of the

topics by answering the 15-item short quiz in the learning management
system (LMS) of this course. Feedback will be given after the
examination is closed.

Good luck!

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References:

GBD 2017 Disease and Injury Incidence and Prevalencre Collaborators. (2018). Global,
regional, and national incidence, prevalence, and years lived with disability for 354
diseases and injuries for 195 countries and territories, 1990–2017: A systematic
analysis for the Global Burden of Disease Study 2017. The Lancet.
https://doi.org/10.1016/S0140-6736(18)32279-7

Isaac, M., Ahmed, H. U., Chaturvedi, S. K., Hopwood, M. J., Javeed, A., Kanba, S., Mufti, A. A.,
Maramis, A., Samaniego, R. M., Udomratn, P., Yanling, H., Zainal, N. Z., & Sartorius, N.
(2018). Postgraduate training in psychiatry in Asia. Current opinion in
psychiatry, 31(5), 396-402. https://doi.org/10.1097/YCO.0000000000000444

Lally, J., Tully, J., & Samaniego, R. (2019). Mental health services in the Philippines. BJPSYCH
International 16(3), 62-64. https://doi.org/10.1192/bji.2018.34

Redaniel, M.T., Lebanan-Dalida, M.A., & Gunnell, D. (2011). Suicide in the Philippines: Time
trend analysis (1974-2005) and literature review. BMC Public Health 11, 536
https://doi.org/10.1186/1471-2458-11-536

Ritchie, H., & Roser, M. (2018). Mental health. https://ourworldindata.org/mental-health

Senate and House of Representatives of the Philippines. (2017). Republic Act no. 11036:
Mental Health Act of 2017. An act establishing a national mental health policy for
the purpose of enhancing the delivery of integrated mental health services,
promoting and protecting persons utilizing psychiatric, neurologic and psychosocial
health services, appropriating funds therefore and for other purposes.
https://www.officialgazette.gov.ph/downloads/2018/06jun/20180620-RA-11036-
RRD.pdf

Tuliao A. P., & Velasquez P. A. (2014). Revisiting the general help seeking questionnaire:
Adaptation, exploratory factor analysis, and further validation in a Filipino College
Student sample. Philippine Journal of Psychology, 47, 1–17.
https://www.academia.edu/7815213/Revisiting_the_General_Help_Seeking_Questi
onnaire_Adaptation_Exploratory_Factor_Analysis_and_Further_Validation_in_a_Fili
pino_College_Student_Sample
Wainberg, M. L., Scorza, P., Shultz, J. M., Helpman, L., Mootz, J. J., Johnson, K. A., Neria, Y.,
Bradford, JM. E., Oquendo, M. A., & Arbuckle, M. R. (2017). Challenges and
opportunities in global mental health: A research-to-practice perspective. Curr
Psychiatry Rep. 19(5). https://doi.org/10.1007/s11920-017-0780-z.
World Health Organization (WHO). (2019). Mental disorders. https://www.who.int/news-
room/fact-sheets/detail/mental-disorder
World Health Organization (WHO). (2015). Global mental health.
https://www.who.int/mental_health/evidence/atlas/interactive_infographic_2015.p
df?ua=1

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Chronic) |8

World Health Organization (WHO). (2014). Global health observatory data repository:
Human resources data by country.
World Health Organization (WHO). (2018). Global health estimates 2016: Deaths by cause,
age, sex, by country and by region, 2000-2016.
World Health Organization (WHO) & Department of Health. (2006). WHO-AIMS Report on
Mental Health System in The Philippines.
World Health Organization (WHO) & Department of Health. (2012). Health Service Delivery
Profile: Philippines.

Chapter 1 Lesson 1: State of Mental Health and Mental Illness in the Country and the World