Mental health is defined as a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and cope with adversity. (US Surgeon General Report, Dec 1999)
Mental illness is a spectrum ranging from less serious to more serious conditions. Physical health can affect mental health, and vice versa.
The spectrum of mental health
The spectrum of mental health ranges from mental wellbeing to diagnosable mental and behavioural disorders that meet specified clinical criteria.
Mental well-being is a state in which the individual can realize his or her potential, cope with the everyday stresses of life, study or work productively, and participate in community life.
The positive dimension of mental health is stressed in the World Health Organization (WHO) constitution, where health is defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Mental well-being is therefore more than the absence of mental illness and cannot be achieved simply by preventing and treating mental disorders. It is also necessary to promote mental well-being by carrying out activities, providing services and creating environments that promote mental health.
Mental difficulties or problems are ways of thinking, feeling or behaving that impact negatively on an adolescent’s quality of life and development.
Mental difficulties or problems can be part of normal adolescent development; may be responses to events in the adolescent’s life or stressors. Mental difficulties or problems do not meet diagnostic criteria of disorders – they have a different duration, severity and impact.
Perceptions of what is “normal” or “abnormal” are determined to a large extent by the social and cultural context. Different ways of thinking and behaving across cultures may influence the way that mental illness manifests and is perceived.
Mental illness manifests through thoughts, feelings and behaviours of an individual.
Mental health is strongly related to other health problems in adolescence, including substance abuse, violence, and sexual and reproductive health.
People who are diagnosed in adulthood with a mental disorder often experience their first episode of the disorder during adolescence. Many of the most serious disorders, such as schizophrenia, bipolar disorder and depression, are identified during the late adolescence or the beginning of adulthood). The pre-existing mental health problems may get worse as the adolescent undergoes this demanding phase of emotional and physical development.
The following are the more common mental and behavioural disorders of adolescence:
Anxiety describes unpleasant feelings of apprehension, tension, fear or worry. These feelings can be associated with physical (bodily, somatic) symptoms, such as a fast heart rate, sweating or shaking. In adolescence, there may also be an effect on development.
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by intrusive thoughts (obsessions) that produce uneasiness, apprehension, fear, or worry; by repetitive behaviours (compulsions) aimed at reducing the associated anxiety; or by a combination of such obsessions and compulsions.
Depression is a common mental disorder during adolescence. It is primarily characterized by sadness (feelings), loss of interest in activities (thoughts, behaviours) and decreased energy (physical symptoms). Other physical symptoms include difficulty concentrating and changes in appetite and sleep.
Sometimes, the physical symptoms are more obvious than the feeling of sadness. It is not uncommon for depression and anxiety to occur together in a mixed anxiety-depressive disorder.
Schizophrenia is a mental disorder where there is disturbed thinking and perception and often inappropriate emotions. Disturbed thinking can be recognized in the form of delusions – beliefs about people or things that remain fixed, despite evidence to the contrary; these are often bizarre or paranoid (e.g. the individual may believe the parents trying to kill him). Disturbed perception can be recognized in the form of hallucinations – sensory perception of something or someone that is not present (e.g. hearing voices that speak about the individual in the third person). Behaviours are also affected and may seem strange to an observer.
Substance use disorders
There are a number of disorders resulting from the abuse of psychoactive substances such as alcohol, opioids (heroin), cannabinoids (marijuana), sedatives and hypnotics, cocaine, other stimulants, hallucinogens, tobacco and volatile solvents. The conditions include acute intoxication, harmful use, dependence and psychotic disorders.
Consequences of adolescent mental illness include:
Some people think that a diagnosis of a mental health problem or a mental disorder implies that the person is doomed to have the problem for the rest of their life. Mental health problems, like physical illnesses, can be short- lived as well. A person diagnosed with mental health problems will not necessarily have the problem for the rest of his or her life.
Mental illness presenting through thoughts, feelings and behaviours
As discussed before, mental illnesses are expressed in thoughts, feelings and behaviours. Here are some examples of how we get information to assess an adolescent’s mental health when they come to the clinic:
In addition to mental illness being evident through a person’s thoughts, feelings and behaviours, mental illness may also manifest as physical (bodily or somatic) symptoms. e.g.:
Other presentations that might indicate underlying adolescent mental illness
There are also other presentations that should alert the health-care provider to possible mental health problems or a need for a mental health assessment, e.g.:
Changes in mood and behaviour can provide important indicators of an adolescent’s mental wellbeing, but these observations alone cannot be conclusive of mental illness – they can only indicate the need to carry out a full assessment.
It is important for health-care providers to be aware of these presentations, as they may point to underlying mental health problems.
The HEADS framework or approach can help the health-care providers assess whether an adolescent is mentally well or ill and, if they are ill, to assess the severity of the illness. The letters of HEADS remind the health-care provider of the issues that need to be discussed with the adolescent:
E Education/employment;Eating; Exercise
S Sexuality; Safety; Suicide and depression.
It is necessary to discuss the HEADS approach in more depth, considering possible warning signs that might point towards adolescent mental illness.
The home environment is an essential part of the adolescent’s life and hence a good area to begin the interview. This will help the health-care provider understand the family situation, e.g. whether the adolescent is living with parents (one or both) or a guardian.Warning signs include the following:
The educational or work environment and the peer group in this setting are important factors in determining the mental health and well-being of adolescents and in influencing their behaviour.
Warning signs include the following:
The health-care provider should enquire about the adolescent’s body image and eating habits. An open-ended question could be “What do you think about your weight?” This opening can lead to questions on the adolescent’s eating habits, e.g. “Warning signs include the following:
The health-care provider should ask the adolescent about their regular exercise routine. Warning signs include the following:
Asking the adolescent about what they enjoy doing for fun can give a picture of their behaviourWarning signs include the following:
The health-care provider should routinely ask all adolescents some general questions about substance use.Warning signs include the following:
This part of the interview requires care, as the information being obtained is sensitive. Discussions on sexuality need to take account of the social and cultural context of the adolescent. Concerns about sexual development, sexuality and sexual abuse are all sensitive topics and need to be approached in a careful and supportive manner with more focus on confidentialityWarning signs include the following:
The health-care provider should ask about safety issues at home, work and school, including questions regarding bullying and violence. Warning signs include the following:
Suicide and depression
Asking the adolescent about their mood and signs and symptoms of depression is important..Warning signs include the following:
The stigma of mental illness
Stigma is a mark of shame, disgrace or disapproval that results in an individual being shunned or rejected by others. In most societies, mental and behavioural disorders are associated with stigma, and this stigma tends to increase as behaviours become increasingly different from the “norm”.
Mental illness might be believed to be associated with evil spirits and magic.
Stigma can prevent people from acknowledging their own mental health problems and from disclosing them to others. Many people do not seek help when they need it for fear of being labelled as “mentally ill”.They can result in
Health-care providers should be aware that adolescents with mental illness are more vulnerable to being abused and badly treated.
Reducing the stigma of mental illness for adolescents
The stigma of mental illness can be reduced by actions at the community and wider societal level. At the community level, there is a need to:
At the societal level, there is a need to:
Myths, misconceptions and negative stereotypes about mental illness are a major cause of the stigma associated with mental illness. Therefore, reducing the stigma of mental illness involves talking openly and accurately about the causes, effects and effective treatment of mental illness. One example of this is to make people aware that most adolescent mental health problems are not permanent and can be treated successfully with bio-psychosocial interventions.
Features of Substance use/abuse in adolescents
Some of the most common symptoms of drug abuse in teenagers include lying, stealing, making repeated excuses (ie for asking for money, going out, going to bath-room) staying in their room, becoming verbally or physically abusive toward others, having items in their possession that are connected to drug use, the smell of drugs on them, mood swings, sleepless nights, changes in friends and academic decline. In addition to these more behavioral symptoms, look for the physical symptoms of drug intoxication and withdrawal.
Adolescents with mental health problems need to be identified in their communities and referred to primary-level health facilities where they should get the care and support they need. Adolescents requiring specialized care need to be referred to referral-level health facilities.
Responding to adolescents with mental health problems at the family and community level
Family members, teachers, youth workers, social workers and other non- health workers could help identify (in their homes, schools and elsewhere in their communities) adolescents experiencing mental health problems. To do this, they need to know what warning signs to be alert to. They also need to know that it is important to look out for these warning signs.
They could also help adolescents experiencing mental health problems by giving them a patient hearing, empathizing and offering advice and support to adolescents to cope with the challenges they are facing and to deal with them effectively. If the symptoms persist or if the adolescent’s ability to function is affected, he or she should be referred to a primary-level health- care facility. Family and community members can make it easier for adolescents to seek help by normalizing and legitimizing care-seeking for mental health problems.
Responding to adolescents with mental health problems at the primary level
Supporting the substance abuser medically is the approach to managing most drug antoxication/withdrawals, sure many substances of abuse can affect bodily functions (for eg. heart rate, blood pressure, breathing rate) In addition to medical management, psycheatric assessment is also required, sence drugs are associated with impaired judgement, secure aggression, assaultive behaviour and ever judicidal homicidal behaviors.Pasychosocial interventions & pharmacotherapy play a vital role in the management of drug dependance and to prevent relapse. Help from mental health professionals & other trained health care professionals makers should be sought the psychosocial intermantions involve the adolescent his/her parents & others concerned persons. The pharmacoceutical agents are used as delerrants or anti crausing agents or healthier and less harmful replacement agents.
Many sectors have complementary contributions to make to crafting an effective overall response to promoting mental health in adolescents, preventing problems from arising, and responding to mental health problems promptly, effectively and sensitively. For this to happen, ministries of health need to:
The term “life skills” refers to a generic set of skills that can be learnt at any stage in life for the promotion of psychosocial competence among young people and that can be applied to many areas of life. The table below gives some examples of life skills.
|Home||Social welfare services||
Educating parents to help them understand the emotional needs of adolescents and how to respond to these needs
Nature of mental health problems that might occur,how to respond to them,and when and how to seek help
Supporting vulnerable adolescents and their families
Building individual assets such as self-esteem and life skills
Discussing sexual health, injuries, violence and substance use; promoting healthy attitudes and behaviours
Making school a safe (i.e.free from physical and emotional violence) and supportive (i.e, where students and staff feel valued and supported) environment
Training teachers to detect adolescents who might need help, provide them with counselling support, and refer those who need medical help to health facilities
Working with social health services to identify and provide support to adolescents living in difficult circumstances
|Community||Community leaders and members||
Engaging and sensitizing community leaders and members to create a caring and supportive environment for adolescents with or at risk of mental health problems,and their families
Engaging and senstizing community members to intervene when there is violence in homes and elsewhere in the community
Training selected community members to detect and refer to health services adolescents who might need help
|Media and Communication Technology||Media Personnel||
Disseminating information on factors contributing to mental health problems in adolescents, on effective ways to prevent mental health problems and respond to them when they occur, and on substance use and mental health problems
Preventing glamorization of suicide
|Communication and interpersonal skills||Decision-making and critical thinking skills||Coping and self-management skils|
Interpersonal communication skills:
Expressing feelings, giving feedback (without blaming), receiving feedback
Decision-making and Information-gathering Skills:
Evaluating future consequences of actions or self and others
Determining alternative solutions to problems
Analysis skills regarding influence of values and attitudes about self and others on motivation
Skills for increasing personal confidence and abilities to assume control, take responsibility, make a difference or bring about change:
Building self-esteem and confidence
Creating self-awareness skills, e.g.awareness of rights, influences, values, attitudes, strengths, weaknesses
Self-evaluation, self assessment, self-monitoring
Negotiation and conflict management
Ability to listen, understand another's needs and circumstances, and express that understanding
Cooperation and teamwork:
Expressing respect for others contributions and different styles
Assessing own abilities and contributing to the group
Critical thinking skills:
Analysing peer and media influences
Analysing attitudes, values, social norms, beliefs, and factors affecting them
Identifying relevant information and sources of information
Skills for managing feelings:
Dealing with grief and anxiety
Coping with loss, abuse and trauma
Skills for managing stress:
Influencing skills, persuasion Networking, motivation
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