IRENE ZEN P.

CORPUS  The program asserts that with proper care, psychosocial

assistance and medication, tens of millions could be treated for
NCM 117 – WEEK 3
depression, schizophrenia, and epilepsy, prevented from suicide
and begin to lead normal lives– even where resources are scarce.
GLOBAL PERSPECTIVES OF MENTAL HEALTH
 The essence of mhGAP is partnerships to reinforce and to
accelerate efforts and increase investments towards providing
services to those who do not have any.

◦ About 1 person worldwide is suffering from a mental

health disorder.

◦ About 1 person in 4 families has a member with a

mental health disorder

◦ Only 1% of the global health workforce provides

mental health care.

◦ Most low- and middle-income countries spend less

than 2$ per person on the treatment and prevention
of mental health disorders.

◦ 76-85% of people with a mental health disorder in

low- and middle-income countries do not receive
treatment.
Numbers of People Affected Globally

◦ 450 million people with mental disorders: Vulnerable Groups

 150 million with depression
 25 million with schizophrenia  Children and adolescents
 38 million with epilepsy  Indigenous populations
 90 million with alcohol or drug use disorder  Women and older adults
 Nearly 1 million commit suicide every year  Disabled individuals
 5 to 10 million attempt to commit suicide every year  Migrants
 Victims of violence, conflicts and disasters
LEADING CAUSES OF YEARS OF LIFE LIVED WITH DISABILITY (YLDs)  Individuals with long mental health suffering
◦ Both waves, all ages, estimates for 2000.  Mental health patients long term hospitalized
1. Unipolar depressive disorders 11.9%
2. Hearing loss, adult onset 4.6%
mhGAP Conditions
3. Iron-deficiency anemia 4.5%
4. Chronic obstructive pulmonary disease 3.3% 1. Depression
5. Alcohol use disorders 3.1% 2. Psychosis
6. Osteoarthritis 3.0% 3. Bipolar disorder
7. Schizophrenia 2.8% 4. Epilepsy
8. Falls 2.8% 5. Developmental disorders
9. Bipolar affective disorder 2.5% 6. Behavioral disorders
10. Asthma 2.1% 7. Dementia
8. Alcohol use and alcohol use disorders
9. Drug use and drug use disorders
Mental Health Gap Action Program (mhGAP) 10. Self-harm/suicide
11. Other significant emotional or medically unexplained complaints
 Mental health gap action program (mhGAP) In 2008, WHO
launched the mental health gap action program (mhGAP) in
response to the wide gap between the resources available and the
resources urgently needed to address the large burden of mental,
neurological, and substance use disorders globally. Through
mhGAP, WHO aims to provide health planners, policy-makers, and
donors with a set of clear and coherent activities and programs for
scaling up care for mental, neurological and substance use
disorders.

 Mental, neurological, and substance use disorders are common in

all regions of the world, affecting every community and age group
across all income countries.

 14% of the global burden of disease is attributed to these

disorders, most of the people affected - 75% in many low-income
countries - do not have access to the treatment they need.

 The WHO Mental Health Gap Action Program (mhGAP) aims at

scaling up services for mental, neurological and substance use
disorders for countries especially with low- and middle-income.
THEORIES/MODELS
1. Psychoanalytic Model
 Sigmund Freud’s psychoanalytic theory of personality development
tells us that human personality is the result of three different but
fundamental structures – the id, the ego, and the superego.
Psychoanalytic theory concentrates on awareness levels combined
with our experiences in early childhood that together can form the
basis of certain mental disorders.
What is Psychoanalytic Theory
 Freud’s psychoanalytic theory explains human personality as a series
of stages that is formed through inner conflicts.
 Freud theorized about how unconscious conflicts occur between
components of the human mind – the id, ego, and superego. Our
levels of consciousness – in his words, consciousness,
preconsciousness, and unconsciousness – also interfere with these
three components. As most of Freud’s research was in the field of
hysteria as well as what we now refer to as post-traumatic stress,
this theory certainly does not apply to everyone in the same way.
*Same idea, different slides
2. Erikson’s Stages of Development
1) Infancy: Trust vs. Mistrust
2) Early Childhood: Autonomy vs. Shame and Doubt
3) Preschool: Initiative vs. Guilt
4) School Age: Industry vs. inferiority
5) Adolescence: Identity vs. Role Confusion
6) Young adulthood: Intimacy vs. Isolation
7) Middle Adulthood: Generativity vs. Stagnation
8) Maturity: Ego Integrity vs. Despair
Conflict During Each Stage
◦ Each stage in Erikson's theory builds on the preceding stages and
paves the way for following periods of development. In each
stage, Erikson believed people experience a conflict that serves as
a turning point in development.
◦ In Erikson's view, these conflicts are centered on either developing
a psychological quality or failing to develop that quality. During
these times, the potential for personal growth is high but so is the
potential for failure.
◦ If people successfully deal with the conflict, they emerge from the
stage with psychological strengths that will serve them well for the
rest of their lives.
◦ If they fail to deal effectively with these conflicts, they may not
develop the essential skills needed for a strong sense of self.
Mastery Leads to Ego Strength
◦ Erikson also believed that a sense of competence motivates
behaviors and actions. Each stage in Erikson's theory is concerned
with becoming competent in an area of life.
◦ If the stage is handled well, the person will feel a sense of mastery,
which is sometimes referred to as ego strength or ego quality. If
the stage is managed poorly, the person will emerge with a sense
of inadequacy in that aspect of development.
3. Interpersonal Model
◦ Harry Stack Sullivan who is considered the father of interpersonal
psychiatry, developed the Interpersonal Theory of Nursing. This
theory explained the role of interpersonal relationships and social
experiences in regards to the shaping of personalities, as well as the
importance of life events to psychopathology. Stack-Sullivan’s theory
states that the purpose of behavior is for the patient to have his or
her needs met through interpersonal interactions, as well as
decrease or avoid anxiety.
◦ The Interpersonal Theory explains six developmental stages, which
Sullivan calls “epochs” or heuristic stages in development.
 The first stage, called Infancy, occurs from birth to eighteen
months. The main characteristic of this stage is the gratification
of needs.
 The second stage begins at eighteen months and runs until six
years of age. This stage, Childhood, is characterized by delayed
gratification.
 The third stage “Juvenile Era”, which occurs between six and
nine years of age, is characterized by the formation of a peer
group.
 The fourth stage, Preadolescence, is between nine and twelve
years of age. It is characterized by the development of
relationships within the same gender.
 Fifth stage, early adolescence occurs from twelve to fourteen
years. During this stage, the adolescent develops an identity
 The sixth stage, late adolescence, runs from fourteen to
twenty-one years of age. This final stage in Stack-Sullivan’s
model of nursing is characterized by the formation of lasting,
intimate relationships.
 The Interpersonal Theory explains three types of self: the good
me, bad me, and not me. The “good me” versus the “bad me”
based on social appraisal and the anxiety that results from
negative feedback. The “not me” refers to the unknown,
repressed component of the self.
◦ Stack-Sullivan’s theory also explains anxiety, self-system, and self-
esteem. It states that security operations are those measures that
the individual employs to reduce anxiety and enhance security. A
self-system is all of the security operations an individual uses to
defend against anxiety and ensure self-esteem.
◦ This model of nursing provides the basis for interpersonal
psychotherapy to specifically address patients with depression and
schizophrenia. The theory proposes that depression most often
develops in the context of adverse events, especially loss
4. Interpersonal Psychotherapy (IPT)
◦ Interpersonal psychotherapy (IPT) is a type of therapy that utilizes
a uniquely structured model for the treatment of mental health
issues.
◦ Based on attachment and communication theories, IPT is designed
to help people address current concerns and improve
interpersonal relationships.
◦ IPT is a time-limited (acutely, 12-16 weeks) treatment with three
phases: a beginning (1-3 sessions), middle, and end (3 sessions).
5. Cognitive Model
◦ The model describes how people's perception, or spontaneous
thoughts about a certain situation influence their emotional,
behavioral (and often physiological) reactions. Cognitive model
tend to be focused on a single cognitive phenomenon or process,
and how two or more processes interact to make behavioral
predictions for a specific task or tool.
◦ All forms of knowing and awareness, such as perceiving,
conceiving, remembering, reasoning, judging, imagining, and
problem solving.
◦ Cognitive development is the construction of thought processes,
including remembering, problem solving, and decision-making,
from childhood through adolescence to adulthood.
Piaget’s Cognitive Model
► Sensorimotor Stage: The child begins to interact with the
environment. 0-2
► Preoperational Stage: The child begins to represent the world
symbolically. 2-6 or 7
► Concrete Operational Stage: The child learns rules such as
conservation. 7-11 or 12
► Formal Operational Stage: The adolescent can transcend the
concrete situation and think about the future. 12-Adulthood

6. Cognitive Behavioral Theory
◦ Aaron Beck
◦ According to Beck (1987), psychological difficulties are due to
automatic thoughts, dysfunctional assumptions, and negative self-
statements.
◦ Aaron T. Beck's cognitive theory of depression proposes that
people susceptible to depression develop inaccurate/unhelpful
core beliefs about themselves, others, and the world as a result of
their learning histories.
7.
Application of Cognitive model to Abnormal psychology: REBT
◦ Rational emotive behavior therapy (REBT) is a type of cognitive
behavioral therapy (CBT) developed by psychologist Albert Ellis.
REBT is an action-oriented approach that’s focused on helping
people deal with irrational beliefs and learn how to manage their
emotions, thoughts, and behaviors in a healthier, more realistic
way.
◦ When people hold irrational beliefs about themselves or the
world, problems can result. The goal of REBT is to help people
recognize and alter those beliefs and negative thinking patterns in
order to overcome psychological problems and mental distress.
◦ According to Ellis, people become depressed, anxious, upset
because of faulty reasoning and a reliance on irrational beliefs and
that people do not respond emotionally to events in the world but
to their beliefs' about those events. Ellis described this as an A-B-C
(Activating Event, Beliefs, Consequences) process.
General Adaptive Syndrome (GAS)
◦ General adaptation syndrome (GAS) describes the physiological
changes your body goes through as it responds to stress. These
changes occur in stages: an alarm reaction (also called fight-or-
flight), a resistance phase (in which your body recovers), and a
period of exhaustion.
◦ Enduring stress has physical and mental effects on the body. And
the more your body goes through the stages of general
adaptation, the greater the risk of long-lasting negative effects.
◦ GAS Triggers: Daily stress, Sudden change, Positive Stress, Trauma
The 3 Stages of General Adaptation Syndrome
1. Alarm Reaction Stage - the alarm reaction stage of general adaptation
syndrome is the body’s initial response to stress. The sympathetic
nervous system is activated by the sudden release of hormones. You
may know this stage as the fight-or-flight response.
► Physical signs of being in the alarm response stage include:
 Dilated pupils
 Increased heart rate
 Rapid breathing
 Trembling
 Pale or flushed skin
 Heightened senses
2. Resistance Stage
 The resistance stage of general adaptation syndrome is when your
body tries to repair itself after the initial shock of stress. If the
stressful situation is no longer present and you can overcome the
stress, your heart and blood pressure will start to return to
prestress levels during this stage.
 However, if the stressful situation continues for a long time or if
you do not resolve the stress, your body will never receive a clear
signal to return to normal functioning levels. This means it will
continue to secrete the stress hormones and your blood pressure
will stay high.
 Prolonged levels of high stress can cause disturbances in the
immune, digestive, cardiovascular, sleep, and reproductive
systems. You might have symptoms such as:
 Bowel issues
 Headaches
 Sleeplessness
 Sadness
 Frustration
 Irritability
 Poor concentration
3. Exhaustion Stage
 Prolonged or chronic stress leads to the last stage of general
adaptation syndrome—exhaustion. Enduring stressors without
relief drains your physical, emotional, and mental resources to the
point where your body is no longer able to cope with stress.
 Signs that you are in the exhaustion stage include:
 Fatigue
 Burnout
 Decreased stress tolerance
 The physical effects of prolonged stress can weaken your immune
system and increase your risk of heart disease, high blood
pressure, diabetes, and other chronic health conditions, including
mental health disorders such as depression or anxiety.
◦ General adaptation syndrome (GAS) describes the process your
body goes through when you are exposed to any kind of stress,
positive or negative. It has three stages: alarm, resistance, and
exhaustion.
◦ If you do not resolve the stress that has triggered GAS, it can lead
to physical and mental health problems.
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