„There is no health without

mental health“

(World Federation on Mental Health)

WHAT IS MENTAL HEALTH ?
The World Health Organization defines
mental health as
 a being of well-being in which the individual
realizes his or her own abilities,
 can cope with the normal stresses of life,
 can work productively and fruitfully, and is
 able to make a contribution to his or her
community"
What is a mental illness?

It is when someone lacks the ability to

manage day to day events and/or
control their behavior so that basic
physical and emotional needs are
threatened or unmet.
 These disorders can affect persons of any
age, race, sex, religion, or income.

Mental illnesses are not the result of a personal

weakness, lack of character, or poor upbringing.
What is mental illness like?

Mental illness is a physical

condition just like asthma or
arthritis.

But still society believes that a

person who is mentally ill
needs to show more
willpower -
to be able to pull themselves
out it.
 mental illness

…..It is also like

telling a person
who has an
amputated leg
to run across
the room.

But a person who has mental health issue

has a “broken brain”.
Concepts of mental health

 mental health is broader than a lack of mental

disorder .
 The concepts include
– subjective well-being,
– perceived self-efficacy,
– autonomy,
– competence,
– intergenerational dependence, and
– self-actualization of one's intellectual and
emotional potential, among others.
Risk Factors:
The causes of mental ill-health

Certain factors can indicate an

increased risk of physically violent
behaviour .
The risk factors should be considered on
an individual basis.
 The causes of mental ill-health

Social
psychological and
physical
Interaction of Individual (biological),
psychological and social factors in the
development
Social factors

life events
• bereavement,
• job loss,
• severe trauma;
• chronic social isolation
• lack of social supports.
• adversity
– unemployment,
– poverty,
– illiteracy,
– child labour and violence);
psychological

 poorly developed coping skills and

 low self-esteem.
 physical.

 poor nutrition,
 infection,
 physical trauma,
 endocrine and
 genetic factors.
 The consequences and impact of
mental ill-health
Mental ill-health burdens in terms of suffering, disability, and mortality,

 loss of economic productivity due to people

– being unable to work, being ill while at work or
– absent from work, or
– from accidents at work.
– Premature death of people with mental illness (for
example, from suicide or from physical illness)
 loss of a breadwinner for the dependent family,
which can lead to poverty.
 mental ill-health leads burden to families.
 prevention and treatment programmes fails due to
– reduced access ,and
– reduced success .
Positive mental health

factors that influence positive

mental health may be clustered
into three key categories:
– At structural level
– At community level
– At individual level
structural level

A satisfactory
– living environments,
– housing,
– employment,
– transport,
– education and
– a supportive political structure.
community level

a sense of belonging,
 social support,
a sense of citizenship and
participation in society
Individual level

ability to deal with

– thoughts,
– feelings
to manage life,
emotional resilience and
the ability to cope with stressful or adverse
circumstances.
Schematic of the
principal parts of the
conceptual overview of
the factors associated
with mental health
FACTS AND MYTHS ABOUT MENTAL
ILLNESS
Myths of Mental Illness

 Mental illness is caused by bad parenting.

Fact: Most diagnosed individuals come from
supportive homes.

 The mentally ill are violent and dangerous.

Fact: Most are victims of violence.

 People with a mental disorder are not smart.

Fact: Numerous studies have shown that many have
average or above average intelligence.
Facts and Myths about Mental Illness
1.Mental health problems only happen to other
people
 Fact: 1 in 4 of the adult population will suffer from
mental health problems in any one year, and one in six
experiences this at any given time. It is estimated that
approximately 450 million people worldwide have a
mental health problem- World Health Organisation
(2001)

2. People with mental illness are violent and

dangerous
 The risk of being killed by a stranger with a severe
mental health problem is roughly 1:10,000,000, about the
same probability as being hit by lightning*. The number
of homicides by people with schizophrenia is around 30
per year. This is 5% of all homicides, the prevalence of
schizophrenia in the population being 1% or less –
 Facts and Myths about Mental Illness

3. People with mental illness are poor and/or less

intelligent
 Mental illness, like physical illness, can affect anyone
regardless of intelligence, social class or income level.
Celebrities such as Stephen Fry, Nick Drake, Paula
Yates, Kurt Cobain, Virginia Woolfe, Brooke Shields
and Winston Churchill have all experienced mental
illness.

4. People who self-harm are attention-seekers

 This is untrue. Most people who self-harm do it in secret
and it’s only when they need to seek medical attention,
that they come to the attention of others
 Facts and Myths about Mental Illness

5. People with poor mental health are weird

 Everyone suffers from low mood and 1 in 4 of the population
will experience mental ill health at some point in their lives.
Think of 12 people you know. Are 3 of them rocking in the
corner muttering to themselves?

6. Mental illness is caused by emotional weakness

 People do not choose to become mentally ill. As with other
medical conditions, like heart disease or diabetes, it has
nothing to do with being weak or lacking will-power.
Facts and Myths about Mental Illness

7. Once you’ve had a mental illness, you never recover

 People can and do recover from mental illness. Medications,
psychological interventions, a strong support network and
alternative therapy treatments from cognitive behavioural
therapy to improved diet and exercise habits are also very
effective in leading to a complete recovery
8. Since ‘care in the community’ was started, people with mental
health problems have been left to roam the streets
 Even before the closure of the old large scale psychiatric
hospitals, around 95% of people received care and treatment for
mental illnesses in the community. What has changed is the type
of accommodation and treatment available. For example, people
requiring long term care in a hospital are usually no longer in
the same building as those requiring short term admissions.
Facts and Myths about Mental Illness

9. All people who suffer from depression are suicidal

 Suicide is not a mental illness. Not everyone who is depressed will
consider suicide. It is as inaccurate as saying that all football fans
are hooligans. However it is true to say that individuals
experiencing a mental health problem are, generally, associated
with a higher risk of suicide. If you suspect someone is feeling
suicidal ,help them – it could help save their lives.

10. If I seek help for my mental health problem, others will think I am
"crazy"
 Early treatment can assist with a faster recovery. If you broke
your arm would you delay getting a cast applied incase people
thought you were weak? Not likely!
KEY ISSUE

Culture, religion, and media play

important roles in how the relationship
between mental illness and suicide is
addressed in different countries
Manifestations of Mental
Disorders
Disturbances of thought and perception
Dysregulation of mood
Inappropriate anxiety
Impulse control and behavioral problems
Cognitive dysfunction
 Positive Symptoms

Positive symptoms are characterized by abnormal thoughts,

perceptions, language and behavior.

 Delusions: False beliefs/thoughts win no basis in reality

 Hallucinations: Disturbances of sensory perception (hearing, seeing or feeling
things not there)
 Disorganized Thinking/Speech: Jumping from topic to topic, responding
to questions with unrelated answers or speaking incoherently
 Disorganized Behavior:Problems in performing directed daily activities.
 Catatonic Behavior: Lowered environmental awareness, unresponsiveness,
rigid posture, resistance to movement or instructions and inappropriate postures.
 Negative Symptoms

Negative symptoms are characterized by restrictions in range and

intensity of emotional expression, communication, body
language and interest in normal activities.

 Blunted (or flat) Affect: Decreased emotional expressiveness, unresponsive

immobile facial appearance, reduced eye contact and body language.
 Alogia: Reduced speech. Responses are detached and speech is not fluid.
 Avolition: Lacking motivation, spontaneity, initiative. Sitting for lengthy
periods or ceasing to participate in work or daily activities.
 Anhedonia: Lacking Pleasure or interest in activities that were once enjoyable.
 Attention Deficit: Difficulty in concentrating
 Stigma and Discrimination
on Mental Health Grounds

 “I feel reluctant to admit I’ve got mental

health problems;
 the stigma and rejection are too hard to
face.”
Key facts

 Stigma and discrimination can affect people

long after the symptoms of mental health
problems have been resolved.
 Discrimination can lead to relapses in mental
health problems and can intensify existing
symptoms.
 Over 80 per cent of respondents feel that
tackling stigma and discrimination should be
a priority.
Key facts

Stigma and discrimination limit people’s aspirations and can make it

difficult to work, access services, participate in communities and
enjoy family life.
 Fewer than four in ten employers say that they would consider
employing someone with a history of mental health problems,
compared to more than six in ten for someone with a physical
disability.
 A third of people with mental health problems report having been
dismissed or forced to resign from their job.
 In one survey, 44 per cent of people with mental health problems felt
that they had experienced discrimination from GPs .
 18 per cent said they would not disclose their condition to a GP.
INDIAN MHA (1987), DETAILS
OF THE ACT, OBJECTIVES,
HIGHLIGHTS & CRITICISM
 INDIAN MHA (1987)

 Prior to 1993, Indian Lunacy Act (ILA), 1912 was

governing the mental health in India
 In 1947, when Indian Psychiatric Society came into
existence, ILA, 1912 was considered insufficient to
safeguard the rights of mentally ill patients
 IPS drafted a mental health bill and submitted it to
govt. of India in 1950
 It took another 28 years for govt. to present it in the
Lok Sabha
 After a gap of another 8 years the bill was adopted as
Mental Health Bill by Rajya Sabha in 1986 and the Lok
Sabha in 1987
 This bill received President’s assent in May, 1987 but
finally came into force after 6 years in April 1993
INDIAN MHA, 1987 (CONTD….)

Terminologies used in the act

NEW TERM OLD TERM

Psychiatric hospital Nursing home Asylum

Mentally ill person Lunatic

Mentally ill prisoner Criminal Lunatic
 INDIAN MHA, 1987 (CONTD….)

 Other important terminologies

– Reception order: Means an order for admission and
detention of a mentally ill person in a psychiatric hospital or
nursing home
– Psychiatric hospital or nursing home: It is a hospital for the
mentally ill persons maintained by the government or
private party with facilities for outpatient treatment and
registered with appropriate licensing authority
– Mentally ill person: Is a person suffering from mental
disorder, other than mental retardation, needing treatment
– Mentally ill prisoner: Is a mentally ill person, ordered for
detention in a psychiatric hospital, jail or other places of safe
custody
OBJECTIVES OF THE ACT

 1. To establish central and state authorities for licensing

and supervising the psychiatric hospitals.
 2. To establish such psychiatric hospitals and nursing
homes.
 3. To provide a check on working of these hospitals.
 4. To provide for the custody of mentally ill persons who
are unable to look after themselves and are dangerous for
themselves and or, others.
 5. To protect the society from dangerous manifestations
of mentally ill.
 OBJECTIVES OF THE ACT
(CONTD….)

 6. To regulate procedure of admission and discharge of mentally ill

persons to the psychiatric hospitals or nursing homes either on
voluntary basis or on request.
 7. To safeguard the rights of these detained individuals.
 8. To protect citizens from being detained unnecessarily.
 9. To provide for the maintenance charges of mentally ill persons
undergoing treatment in such hospitals.
 10. To provide legal aid to poor mentally ill criminals at state
expenses
 11. To change offensive terminologies of Indian Lunacy act to new
soother ones.
 Procedure for admission and
discharge of
mentally ill
 A mentally ill person (not a minor) may make a request for
admission as a voluntary patient; in case of minor his
guardian may make such request. On such request, medical
officer in-charge after enquiry within 24 hrs, if thinks
necessary may admit such person.
 The medical officer shall discharge such patients on request
by him or guardian as the case may be, unless he finds such
discharge against patient's interests.
 Such cases will be referred to medical board, which if
decides the same, then patient will be further admitted for a
period not exceeding 90 days for treatment.
 POSITIVE CHANGES IN THE MHA, 1987

 A mentally ill may be admitted as inpatient on a

request by friends or relatives. Such request
should be supported by medical certificates to the
effect.
 In such cases medical officer in-charge may
admit the patient if he thinks necessary.
 Request for admission may also be made by a
police officer if such mentally ill person is
dangerous to himself or others.
 Such persons will be discharged by magistrate on
request by friends/relatives or after they are
certified to be sane by the board of experts.
POSITIVE CHANGES IN THE
MHA, 1987 (CONTD….)

 Special centres for special population like drug addicts,

under 16 years, mentally ill prisoners etc.
 Establishment and maintenance of psychiatric hospitals
and psychiatric nursing homes in private sector which
was not in the earlier law
 Discharge procedure have been made easy and more
simplified
 There are new additions in this law like protection of
human rights of mentally ill persons, penalties, cost of
maintenance and management of properties of mentally
ill persons
 Prohibition on any research on subjects without proper
consent
 CRITICAL ASPECTS OF MHA
1987 AS A WHOLE
– The act doesn’t reflect the govt. policy on mental health
framed in 1978 as well as Mental Health Programme,1987
– No attention to WHO guidelines
– Legal considerations have been given more weightage in
comparison to medical ones
– Failed to remove the criminal flavour by keeping the power of
criminal court to exert its control over admissions and
discharge of non criminal mentally ill persons
– There are no provisions for punishing the relatives and officers
requesting unnecessary detention of a person to such hospitals
 CRITICAL ASPECTS OF MHA
1987 AS A WHOLE (CONTD….)

– No importance to family and community psychiatry

– Once a person is admitted to mental hospital he is termed
insane or mad by the society. There should be provisions in
the act to educate the society against these misconceptions
– Much stress is laid on hospital admission and treatment. This
again increases the cost of health care. No provisions are
made for home treatment
– The act has no provision for transportation of an unwilling
patient except by police
Conclusion

 Every law has its own advantages and

disadvantages although existing law gives
an excellent approach to the problems of
mentally ill.
 But some of the provisions need a proper
rethinking.
 No law once framed can be adapted forever.
 There should be proper amendments from
time to time.
 Conclusion

Overall, mental health is an

issue that effects everyone.

And hopefully, throughout the

years, education will curve
the sigma of these brain
disorders so that hate, bias
judgment and
discrimination will be gone.