mental disorder essay introduction

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Essay on Mental Health

According to WHO, there is no single 'official' definition of mental health. Mental health refers to a person's psychological, emotional, and social well-being; it influences what they feel and how they think, and behave. The state of cognitive and behavioural well-being is referred to as mental health. The term 'mental health' is also used to refer to the absence of mental disease. 

Mental health means keeping our minds healthy. Mankind generally is more focused on keeping their physical body healthy. People tend to ignore the state of their minds. Human superiority over other animals lies in his superior mind. Man has been able to control life due to his highly developed brain. So, it becomes very important for a man to keep both his body and mind fit and healthy. Both physical and mental health are equally important for better performance and results.

Importance of Mental Health 

An emotionally fit and stable person always feels vibrant and truly alive and can easily manage emotionally difficult situations. To be emotionally strong, one has to be physically fit too. Although mental health is a personal issue, what affects one person may or may not affect another; yet, several key elements lead to mental health issues.

Many emotional factors have a significant effect on our fitness level like depression, aggression, negative thinking, frustration, and fear, etc. A physically fit person is always in a good mood and can easily cope up with situations of distress and depression resulting in regular training contributing to a good physical fitness standard. 

Mental fitness implies a state of psychological well-being. It denotes having a positive sense of how we feel, think, and act, which improves one’s ability to enjoy life. It contributes to one’s inner ability to be self-determined. It is a proactive, positive term and forsakes negative thoughts that may come to mind. The term mental fitness is increasingly being used by psychologists, mental health practitioners, schools, organisations, and the general population to denote logical thinking, clear comprehension, and reasoning ability.

 Negative Impact of Mental Health

The way we physically fall sick, we can also fall sick mentally. Mental illness is the instability of one’s health, which includes changes in emotion, thinking, and behaviour. Mental illness can be caused due to stress or reaction to a certain incident. It could also arise due to genetic factors, biochemical imbalances, child abuse or trauma, social disadvantage, poor physical health condition, etc. Mental illness is curable. One can seek help from the experts in this particular area or can overcome this illness by positive thinking and changing their lifestyle.

Regular fitness exercises like morning walks, yoga, and meditation have proved to be great medicine for curing mental health. Besides this, it is imperative to have a good diet and enough sleep. A person needs 7 to 9 hours of sleep every night on average. When someone is tired yet still can't sleep, it's a symptom that their mental health is unstable. Overworking oneself can sometimes result in not just physical tiredness but also significant mental exhaustion. As a result, people get insomnia (the inability to fall asleep). Anxiety is another indicator. 

There are many symptoms of mental health issues that differ from person to person and among the different kinds of issues as well. For instance, panic attacks and racing thoughts are common side effects. As a result of this mental strain, a person may experience chest aches and breathing difficulties. Another sign of poor mental health is a lack of focus. It occurs when you have too much going on in your life at once, and you begin to make thoughtless mistakes, resulting in a loss of capacity to focus effectively. Another element is being on edge all of the time.

It's noticeable when you're quickly irritated by minor events or statements, become offended, and argue with your family, friends, or co-workers. It occurs as a result of a build-up of internal irritation. A sense of alienation from your loved ones might have a negative influence on your mental health. It makes you feel lonely and might even put you in a state of despair. You can prevent mental illness by taking care of yourself like calming your mind by listening to soft music, being more social, setting realistic goals for yourself, and taking care of your body. 

Surround yourself with individuals who understand your circumstances and respect you as the unique individual that you are. This practice will assist you in dealing with the sickness successfully.  Improve your mental health knowledge to receive the help you need to deal with the problem. To gain emotional support, connect with other people, family, and friends.  Always remember to be grateful in life.  Pursue a hobby or any other creative activity that you enjoy.

What does Experts say

Many health experts have stated that mental, social, and emotional health is an important part of overall fitness. Physical fitness is a combination of physical, emotional, and mental fitness. Emotional fitness has been recognized as the state in which the mind is capable of staying away from negative thoughts and can focus on creative and constructive tasks. 

He should not overreact to situations. He should not get upset or disturbed by setbacks, which are parts of life. Those who do so are not emotionally fit though they may be physically strong and healthy. There are no gyms to set this right but yoga, meditation, and reading books, which tell us how to be emotionally strong, help to acquire emotional fitness. 

Stress and depression can lead to a variety of serious health problems, including suicide in extreme situations. Being mentally healthy extends your life by allowing you to experience more joy and happiness. Mental health also improves our ability to think clearly and boosts our self-esteem. We may also connect spiritually with ourselves and serve as role models for others. We'd also be able to serve people without being a mental drain on them. 

Mental sickness is becoming a growing issue in the 21st century. Not everyone receives the help that they need. Even though mental illness is common these days and can affect anyone, there is still a stigma attached to it. People are still reluctant to accept the illness of mind because of this stigma. They feel shame to acknowledge it and seek help from the doctors. It's important to remember that "mental health" and "mental sickness" are not interchangeable.

Mental health and mental illness are inextricably linked. Individuals with good mental health can develop mental illness, while those with no mental disease can have poor mental health. Mental illness does not imply that someone is insane, and it is not anything to be embarrassed by. Our society's perception of mental disease or disorder must shift. Mental health cannot be separated from physical health. They both are equally important for a person. 

Our society needs to change its perception of mental illness or disorder. People have to remove the stigma attached to this illness and educate themselves about it. Only about 20% of adolescents and children with diagnosable mental health issues receive the therapy they need. 

According to research conducted on adults, mental illness affects 19% of the adult population. Nearly one in every five children and adolescents on the globe has a mental illness. Depression, which affects 246 million people worldwide, is one of the leading causes of disability. If  mental illness is not treated at the correct time then the consequences can be grave.

One of the essential roles of school and education is to protect boys’ and girls' mental health as teenagers are at a high risk of mental health issues. It can also impair the proper growth and development of various emotional and social skills in teenagers. Many factors can cause such problems in children. Feelings of inferiority and insecurity are the two key factors that have the greatest impact. As a result, they lose their independence and confidence, which can be avoided by encouraging the children to believe in themselves at all times. 

To make people more aware of mental health, 10th October is observed as World Mental Health. The object of this day is to spread awareness about mental health issues around the world and make all efforts in the support of mental health.

The mind is one of the most powerful organs in the body, regulating the functioning of all other organs. When our minds are unstable, they affect the whole functioning of our bodies. Being both physically and emotionally fit is the key to success in all aspects of life. People should be aware of the consequences of mental illness and must give utmost importance to keeping the mind healthy like the way the physical body is kept healthy. Mental and physical health cannot be separated from each other. And only when both are balanced can we call a person perfectly healthy and well. So, it is crucial for everyone to work towards achieving a balance between mental and physical wellbeing and get the necessary help when either of them falters.

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What is a mental disorder? An exemplar-focused approach

Dan j. stein.

1 SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa

Andrea C. Palk

2 Department of Philosophy, Stellenbosch University, Stellenbosch, South Africa

Kenneth S. Kendler

3 Virginia Institute of Psychiatric and Behavioral Genetics and Departments of Psychiatry, and Human and Molecular Genetics, School of Medicine/Virginia Commonwealth University, VA, USA

The question of ‘what is a mental disorder?’ is central to the philosophy of psychiatry, and has crucial practical implications for psychiatric nosology. Rather than approaching the problem in terms of abstractions, we review a series of exemplars – real-world examples of problematic cases that emerged during work on and immediately after DSM-5, with the aim of developing practical guidelines for addressing future proposals. We consider cases where (1) there is harm but no clear dysfunction, (2) there is dysfunction but no clear harm, and (3) there is possible dysfunction and/or harm, but this is controversial for various reasons. We found no specific criteria to determine whether future proposals for new entities should be accepted or rejected; any such proposal will need to be assessed on its particular merits, using practical judgment. Nevertheless, several suggestions for the field emerged. First, while harm is useful for defining mental disorder, some proposed entities may require careful consideration of individual v. societal harm, as well as of societal accommodation. Second, while dysfunction is useful for defining mental disorder, the field would benefit from more sharply defined indicators of dysfunction. Third, it would be useful to incorporate evidence of diagnostic validity and clinical utility into the definition of mental disorder, and to further clarify the type and extent of data needed to support such judgments.

Introduction

The question of ‘what is a mental disorder?’ is foundational in philosophy of psychiatry, and also has enormous practical importance for clinicians and patients. This question has therefore been addressed in successive revisions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). Given ongoing work on the revision of DSM-5, it is timely to ask this question again.

Many previous attempts have applied a conceptual approach to the definition of mental disorder. These have produced limited progress, particularly in assisting with decisions about specific conditions. Thus, it may be useful to try a different approach to this critical problem. Rather than focusing on abstractions, we review a series of exemplars – real-world examples of problematic cases that emerged during work on and immediately after DSM-5. From these cases, we hoped to extract practical guidelines for considering future proposals for the inclusion of entities in the nosology.

What is a mental disorder?

The question of ‘what is a mental disorder’, is crucial, in part, because the real possibility exists of erroneously classifying various kinds of social deviance or behavioral variation as ‘disorder’, when they are better conceptualized using other categories, such as ‘non-pathological individual differences’, ‘lifestyle choice’, or ‘crime’. A paradigmatic example from DSM is that of homosexuality, which was conceptualized in DSM-I as a disorder, (American Psychiatric Association, 1952 ) but by DSM-5 was no longer mentioned (American Psychiatric Association, 2013 ; Drescher, 2015 ).

Many authors have emphasized that what counts as a disease or disorder changes over time and across place, and have accused medicine and psychiatry of failing to recognize how idioms of distress are shaped by culture (Kirmayer, 2005 ; Kleinman, 1988 ). Others have accused the DSM of over-medicalizing (Frances, 2014 ; Horwitz, 2007 ; Szasz, 2007 ). These criticisms are driven by disagreements about the advantages and disadvantages of the medicalization of putative mental conditions. Central to these debates is the degree to which our disorders can be best understood as independent biological entities (naturalism/objectivism) or value-laden social constructs (normativism/constructivism) (Agich, 1983 ; Boorse, 1975 ; Fulford, 2001 ; Nordenfelt, 2007 ; Sadler, 2005 ; Stein, 2008 ; Zachar & Kendler, 2017 ).

Prior proposals have attempted to move beyond the polarities of naturalism and constructivism. Zachar suggested that mental disorders are ‘practical kinds’ (Zachar, 2002 ), shifting the issue from whether disorder categories reference scientific entities, to how effectively they facilitate particular scientific or clinical goals (Zachar & Kendler, 2017 ). In influential work, Wakefield defined mental disorders as ‘harmful dysfunctions’, and depicted dysfunction in evolutionary terms (Wakefield, 1992 ).

A strong form of realism holds that, just as the periodic table depicts the properties of molecular entities, so a medical or psychiatric nosology can carve nature at its joints – as a series of ‘natural kinds’ (Kendler, 2016 ; Stein, 2008 ). Softer forms of realism, likely more appropriate for conceptualizing mental disorders, regard exemplars like biological species as more appropriate for psychiatric disorders as the boundaries between different species are fuzzy, and not amenable to depiction in tabular format (Kendler, 2016 ; Stein, 2008 ).

We find aspects of both pragmatic approaches and Wakefield's characterization helpful, and use them as a framework for organizing our exemplars. More specifically, in reviewing real-world cases relevant to DSM-5 we will rely on the notions of ‘harm’ and of ‘dysfunction’. Harm may be indexed by the presence of distress and impairment, while dysfunction may be inferred when psychobiological mechanisms produce symptoms and associated harm. Nevertheless, as our exemplars will demonstrate, judgments about harm and dysfunction entail a range of additional complex considerations.

DSM definitions of mental disorder

DSM has responded to these debates in its definitions of mental disorders. Thus DSM-III emphasizes, for example, that clinicians should not misclassify or label a cultural expression of distress or political deviance as a disease (American Psychiatric Association, 1980 ). Subsequent editions of DSM have emphasized that the boundaries of mental disorders are fuzzy ( Table 1 ) (American Psychiatric Association, 2000 , 2013 ).

DSM-IV definition of mental disorder

During the development of DSM-5, along with others, we attempted to further clarify the DSM criteria for a mental disorder ( Table 2 ) (Stein et al., 2010 ). While our proposal differs modestly from the later DSM-5 wording ( Table 3 ), three differences are relevant here. First, while the DSM-5 definition refers to dysfunction in ‘psychological, biological, or developmental processes,’ we prefer ‘psychobiological’, to emphasize that psychology and biology are intertwined constructs that encompass development, as well as other life-course constructs.

DSM-V proposal for the definition of mental/psychiatric disorder

DSM-5 definition of mental disorder

Second, our proposal suggested that the consequences of a mental disorder are clinically significant distress or disability (B). The DSM-5 wording indicates that mental disorders are usually associated with significant distress or impairment. The word ‘usually’ may be technically accurate, in that on rare occasions, a mental disorder is listed in DSM-5, and there is no ‘clinical criterion’ (First & Wakefield, 2013 ). However, given that psychiatric symptoms are often on a continuum with normality, the clinical criterion is one key way of providing a relatively valid and reliable marker of underlying dysfunction, so lessening the risk of false positives and over-medicalization (Cooper, 2013 ). Other ways in which clinical criteria can validly and reliably point to underlying dysfunction include descriptions of symptom severity, excessiveness, frequency, and duration (First & Wakefield, 2013 ).

Third, our proposal made reference to considerations of diagnostic validity and clinical utility. This explicitly emphasizes that decisions about proposals for new entities must address empirical data. Certainly, data on diagnostic validity and clinical utility of proposed entities were carefully assessed during the DSM-5 revision process.

Examining different exemplars

We now turn to a number of test-cases that emerged during DSM-5. While conceptual work is crucial, it is important to examine its conclusions in the context of specific empirical examples, which may then produce greater clarity on the underlying conceptual issues.

We explore, in turn, several different types of cases, categorized along the following lines: (1) entities associated with harm, but for which there is limited evidence of underlying dysfunction, (2) entities involving dysfunction but without strong evidence that they produce harm, and (3) entities involving possible harm and dysfunction, and thus possibly indicative of a disorder, but which are controversial for various reasons. While the third category deals explicitly with controversial cases, controversy is present in all three categories.

Harm but no clear psychobiological dysfunction

A number of conditions are associated with harm to individuals and/or society, but are not considered disorders because they lack evidence of underlying psychobiological dysfunction. Entities that fall under this rubric include unwanted physical, mental, or behavioral changes (e.g. those that accompany aging), more enduring traits that entail suffering or produce negative impacts but are not considered disorders (e.g. laziness), and behavior that is more appropriately classified as culturally or socially deviant rather than as a mental disorder (e.g. racism). The appropriate responses to distress or impairment associated with these entities would generally be regarded as emanating from moral, cultural, or social domains, rather than from the domain of health. Closer examination of specific exemplars suggests, however, that judgments of whether or not an entity should be included in the nosology reflect a number of different considerations ( Table 4 ).

Key considerations regarding the inclusion of putative entities in the nosology

Aging is associated with a range of negative sequelae. Furthermore, there is a growing understanding of the specific psychobiological mechanisms that lead to symptoms associated with aging and these harms, bolstering the claim that aging involves dysfunction (De Grey, 2007 ). That said, a range of causal mechanisms presumably underly the spectrum of aging from premature aging (e.g. progeria) to typical senescence. Indeed, a view that emphasizes the normality of aging may concede that physicians counsel individuals on a range of measures to sustain health and curb aging but call into question the inclusion of mild neurocognitive disorder in DSM-5. The concern is that this risks pathologizing minor forgetfulness associated with the aging process, particularly given the lack of treatment and the potentially harmful effects of receiving such a diagnosis (Rattan, 2014 ). That said, the more future medical interventions for mild neurocognitive disorder target mechanisms relevant to premature aging, and are shown efficacious and cost-effective, the more useful such a diagnosis will, arguably, be. Thus, judgments about the inclusion of entities in the nosology may, in part, reflect the existence, efficacy, and cost-efficiency of health interventions.

Time-limited and non-incapacitating anxiety associated with threat (e.g. a possible job loss), and suffering associated with loss (e.g. death of a parent), may be experienced as unwelcome, and clinicians may play a useful role in helping to alleviate them. Nevertheless, anxiety and sadness in the face of threat and loss are generally considered to be appropriate, rather than dysfunctional, responses. During the development of DSM-5, there was considerable debate about the removal of the bereavement exclusion criteria from the diagnosis of major depression (Zachar, First, & Kendler, 2017 ). The removal of this clause is consistent with the fact that depressions that are precipitated by a range of other common stressors (e.g. romantic rejection; serious medical problems) were not excluded. While critics argued that this decision reflected over-medicalization, a counter-argument is that it is important to ensure that diagnostic criteria allow appropriate diagnosis and treatment of depression in the context of bereavement (Prigerson, Boelen, Xu, Smith, & Maciejewski, 2021 ). Thus, judgments about thresholds for a putative disorder in the nosology may require consideration of epistemic values such as the internal consistency of criteria.

Racism is a phenomenon that has been associated with great harm and suffering (Schmitt, Branscombe, Postmes, & Garcia, 2014 ). While extreme racism may be a symptom of psychopathology, and there is some evidence of an association between, for example, racism and certain personality types (Adorno, 1969 ), there is little evidence that racism, in general, is the result of underlying psychobiological dysfunction. Rather, there is relatively widespread consensus that racist beliefs and behavior are largely a product of socialization and culture. We would therefore argue that racism is not a disorder; it is a phenomenon that, while sanctioned in some cultures in the past, is now a form of social deviance that should be addressed by a range of different social and educational interventions. Thus, judgments about the inclusion of an entity in the nosology may require rigorous reflection on cultural and social values.

Similar logic would hold for a range of other socially deviant or problematic behaviors (Aristotle, 1985 ), including those redolent of the seven deadly sins of laziness, gluttony, acquisitiveness, aggression, lust, jealousy, and pride. Prima facie, these are more appropriately understood and responded to in moral or socio-cultural terms rather than with health interventions. That said, psychotherapy may usefully target such behaviors or traits, and public health may usefully advocate for healthy eating and sexual behaviors. Furthermore, this matter is complicated by the fact that when clearly excessive, such traits can point to underlying psychobiological dysfunction; indeed, symptoms such as apathy, hyperphagia, hoarding, violence, hypersexuality, obsessional jealousy, and grandiosity may be indicative of a psychiatric disorder, and are appropriately listed in the DSM-5 glossary. Thus, judgments about the inclusion of a disorder in the nosology are based, in part, on evidence of clear excessiveness of behaviors/traits, and associated features that point to dysfunction.

Psychobiological dysfunction but no clear harm

In this category, we include various conditions for which there is some evidence of underlying psychobiological dysfunction, even if this is not fully understood. Conditions in this category may have been regarded as harmful, in the sense of disadvantageous, or socially deviant, in the past, but this view has been contested due to social change. While conditions in this category may point to differences rather than disorder, individuals with these conditions may still experience disadvantage and suffering. It may therefore be crucial to ensure support and treatment for those who seek it. Again, a closer examination of specific exemplars suggests that judgments of whether or not an entity should be included in the nosology reflect a number of different considerations ( Table 4 ).

The notion of disability has been extensively challenged by rights-based advocacy groups and organizations that have focused on promoting inclusivity, equality, and respect (Charlton, 1998 ). A paradigmatic example is deafness, which although not a psychiatric entity, is nevertheless useful as a point of departure for further discussion of analogous behavioral conditions where the presence of harm is contested. Deafness is the result of underlying alterations in structures and mechanisms of hearing, consistent with dysfunction. Moreover, given the challenges of participating in a hearing society, deafness has been widely viewed as disadvantageous, and characterized as a medical condition. However, this has been challenged by the view that deafness itself is not intrinsically harmful; rather, it is societal responses, or lack of response in terms of ensuring adequate accommodation, that produces harm. A view of deafness as a disability has been replaced with a view of deafness as a cultural identity (Padden & Humphries, 2005 ). This identity is referred to as Deaf, rather than deaf, which refers simply to hearing loss. While there have been rare, but controversial, cases of Deaf parents wishing to utilize preimplantation genetic diagnosis to select for deafness, many members of the Deaf community, given the choice of having children with or without hearing, opt for the former (Camporesi, 2010 ; Wallis, 2020 ).

Deaf culture has some parallels with groups that are open about their unusual psychological behaviors or traits, but who argue that these are not associated with harm. It turns out, for example, that hearing voice is prevalent in the general population, and that these experiences may not necessarily be indicative of a serious mental disorder (Maijer, Begemann, Palmen, Leucht, & Sommer, 2018 ). In the absence of harm, it is difficult to argue for the medicalization of such experiences, and there are now support groups for those with these experiences (Longden, 2017 ). That said, hearing voices may be a symptom of a range of mental disorders, other than psychotic disorders, and there is evidence from community surveys that such symptoms are associated with significant disability, which is unlikely to be simply a reflection of lack of social accommodation (Navarro-Mateu et al., 2017 ; Pierre, 2010 ). Thus, judgments about whether or not an entity should be included in the nosology require nuanced assessment of the extent of harm, as reflected in distress and impairment.

Autistic spectrum disorder (ASD) which is associated with alterations in structures and mechanisms underlying behavior (Van Rooij et al., 2018 ), has traditionally been viewed as a harmful condition. However, there is a contrary position, which may be particularly relevant to milder cases of ASD. In this view, the positive attributes associated with ASD (e.g. high levels of creativity and mathematical ability) are emphasized and neurodiversity is celebrated, shifting the onus onto neuro-typical society to accommodate neuro-atypical persons (Glannon, 2007 ). However, despite the growing prevalence of persons with ASD who choose to see themselves as situated on a spectrum of normal variation, there are many individuals and families who seek health interventions or advocate for more scientific research to cure or prevent ASD (Walsh, Elsabbagh, Bolton, & Singh, 2011 ). These disagreements are perhaps indicative of the heterogeneous and dimensional nature of both ASD and its impact; in severe cases care rather than accommodation is required. Thus, judgments about whether or not an entity should be included in the nosology require careful assessment of the extent to which social accommodation is possible.

A similar set of issues emerges for gender identity disorder (GID) or transsexualism, which were removed from DSM-5 and ICD-11 and replaced by gender dysphoria (GD) and gender incongruence, respectively. These latter categories address cases in which there is significant distress due to conflicts between assigned and identified gender. In the case of GD, there is some preliminary evidence of neuroanatomical differences between transgender and cisgender persons which may arguably indicate underlying dysfunction (Burke, Manzouri, & Savic, 2017 ). Moreover, there is also some evidence of harmfulness, for example, a high risk of suicide (Garcia-Vega, Camero, Fernandez, & Villaverde, 2018 ). This could be sufficient for inclusion in our third category, however, we mention GD here because, despite the evidence that distress is intrinsic to the condition, it has also been argued that this distress is a product of stigmatization and social rejection. The shift from social rejection to acceptance of homosexuality, has bolstered this argument for some. On the other hand, from a clinical utility perspective, the inclusion of GD in the nosology is precisely important for ensuring medical and psychiatric care for individuals with this condition who request such care. Judgments about whether or not an entity should be included in the nosology may require careful balancing of the advantages and disadvantages of medicalization (Parens, 2013 ).

Possible harm and psychobiological dysfunction, but controversial

In the third category, we include conditions for which there is some evidence of underlying psychobiological dysfunction and actual or potential harm, but which are controversial for various reasons. First, the controversy may be attributed to a lack of certainty about whether or not a condition does, in fact, reflect underlying psychobiological dysfunction, or whether inclusion would represent over-medicalization. Second, the controversy could arise due to the fact that harm, in the sense of clinically significant distress or impairment, may be present only as a risk, which may not be actualized, so that inclusion of the condition may lead to overdiagnosis. Concerns about medicalization and overdiagnosis both reflect a critical stance towards the expansion of disorder constructs (Hofmann, 2016 ). Third, a condition may be indicative of disorder but considered controversial, in the sense of inappropriate for inclusion in the nosology, due to various pragmatic concerns. This could include a risk of misuse in legal contexts or negative implications for public health. These kinds of pragmatic considerations shift the focus from whether or not a condition is a disorder to whether or not a particular disorder belongs in a diagnostic manual ( Table 4 ).

Medicalization concerns

Compulsive sexual behavior disorder was rejected for DSM-5 but is included in ICD-11 as an impulse control disorder (Grant & Chamberlain, 2016 ). There is a growing evidence base on this disorder. Still, hypersexuality is not necessarily pathological, and there is currently little direct evidence that those who present clinically for the treatment of compulsive sexual behavior have underlying psychobiological dysfunction. Thus, such dysfunction needs to be inferred on the basis of clinical criteria such as severity and duration of symptoms (Kafka, 2010 ). As noted earlier, psychiatry should be wary of medicalizing conditions redolent of the seven sins, focusing rather on advocating for healthy sexual behavior. At the same time, psychiatry clearly has a role when hypersexuality reflects an underlying medical or psychiatric disorder, and it may well have a role when symptoms are truly excessive and associated with a great deal of distress and impairment. For example, it is not clear whether a person who compulsively watches pornography, but is able to limit viewing to the privacy of the home, has a disorder. While personal relationships may be negatively impacted, such a person can be described as functioning, as long as there is control over the behavior. We would be more inclined to regard a person who cannot limit viewing of pornography to a particular time of day or place and feels compelled to watch it while at work, with risk of job loss, as having a disorder. Judgments about whether or not an entity should be included in the nosology may require careful assessment of the degree of loss of control, and related impairment, particularly in the case of compulsive or addictive behaviors.

Internet gaming disorder was included in DSM-5 as a condition for further study, and gaming disorder is included as a mental disorder in ICD-11 (Billieux, Flayelle, Rumpf, & Stein, 2019 ). There is some evidence of underlying alterations in psychobiological structures and mechanisms in gambling disorder, which is included in both nosologies, but less evidence that this is the case in gaming disorder. Behavioral addictions are controversial partly because they raise questions as to whether underlying alterations in structures or mechanisms are sufficient to explain the behavior (which may be viewed as a lifestyle choice rather than as a loss of control). Proposals for new behavioral addictions such as gaming disorder also face the difficulty that there is simply less evidence for newly emergent conditions. Similarly, the brain disease model of substance use disorders has been critiqued (Hammer et al., 2013 ). Still, there is a strong argument that substance use disorders are mental disorders, with evidence of alterations in a range of psychobiological processes that are associated with loss of control, and that can be targeted by health interventions.

Overdiagnosis concerns

Attenuated psychosis syndrome (APS), which is associated both with evidence of psychobiological dysfunction and potential harm in the case of conversion, was included in DSM-5 as a condition for further study (Tsuang et al., 2013 ). APS elicits concerns about overdiagnosis, mainly due to the possibility that interventions for individuals who meet the criteria may cause harm (Zachar, First, & Kendler, 2020 ). There are some parallels between APS and other risk-syndromes such as hypercholesterolaemia or hypertension. Once it was clear that high levels of cholesterol were risky, these were defined as pathological. With the introduction of statins, and evidence that these agents lowered risks, thresholds for diagnosis were lowered; with the introduction of generic statins, and great cost-efficiencies, such thresholds were further decreased. It is possible that an analogous perspective may be useful in defining thresholds for anxiety disorders and depression. However, in the case of APS, there are arguably insufficient data demonstrating risk if untreated, as well as insufficient data demonstrating safety, efficacy, and cost-efficiency of interventions. Moreover, medical risk-syndromes may differ from the risk associated with a psychotic disorder due to the high levels of stigmatization associated with the latter. Nevertheless, it is possible that the issue of whether, and when, to intervene in the case of evidence of psychiatric risk will become increasingly pertinent given the potential for identifying predictive biomarkers – for example, from molecular genetics research (Palk, Dalvie, de Vries, Martin, & Stein, 2019 ).

Suicidal behavior disorder is included in DSM-5 as a condition for further study. Clearly, it is important for clinicians to be aware of suicidal behavior, and this is often an important target of treatment. On the other hand, suicidal behavior may be due to a range of different mental disorders, reflecting a range of different kinds of dysfunction. Furthermore, suicidal behavior is not always associated with a mental disorder; there is a compelling argument that in particular medical circumstances, it is understandable and appropriate for patients to make a decision to end their lives. Suicide can also arise as a form of political protest or a culturally sanctioned response to shame. Judgments about diagnostic validity may be complex, including consideration of a range of different empirical data of varying quality. This point is also exemplified by other entities included in DSM-5 as conditions for further study, namely persistent complex bereavement disorder, depressive episodes with short-duration hypomania, caffeine use disorder, non-suicidal self-injury, and neurobehavioral disorder associated with prenatal alcohol exposure (American Psychiatric Association, 2013 ).

Pragmatic concerns

Simple (type) schizophrenia (SS) or simple deteriorative disorder has long been controversial (Serra-Mestres et al., 2000 ). It has not been included in the nosology since DSM-III (although it was included in DSM-IV as a condition for further study), and while it was in ICD-10 it is not in ICD-11. There is indeed some evidence that simple schizophrenia is a rare deteriorative disorder characterized by nonspecific negative symptoms and an absence of psychotic symptoms. However, while previous iterations of DSM contained schizophrenia sub-types, these were appropriately removed due to a lack of diagnostic validity and reliability, and evidence that schizophrenia is a spectrum disorder (Serra-Mestres et al., 2000 ; Whitwell, Bramham, & Moriarty, 2018 ). Nevertheless, the fact that there continue to be patients who present with these kinds of deteriorative symptoms has been used to support claims that the diagnosis remains relevant (Whitwell et al., 2018 ). This exemplar illustrates that there is a distinction between judgments regarding whether a condition is a mental disorder, and judgments regarding whether it should be included in the nosology.

Paraphilic coercive disorder (PCD) was considered, but ultimately rejected, for inclusion in DSM-5 (Stern, 2010 ). PCD illustrates issues at the boundary between the medical and legal systems, and highlights disagreements about the nature of psychopathology and moral responsibility. There is inconclusive evidence of underlying psychobiological dysfunction or of harm to the individual (other than that following legal transgression) (Knight, 2010 ). However, more relevant here is the real risk of the PCD diagnosis being misused in legal contexts to either inappropriately exculpate a rapist, or to detain persons indefinitely, if deemed to be at risk of sexual reoffending (Wakefield, 2011 ). The debates surrounding PCD highlight how pragmatic considerations inform decisions about nosology. Such considerations include maintaining societal trust in the integrity of psychiatric diagnosis and protecting the reputation of the profession, as well as anticipating potentially harmful consequences of including certain constructs as disorders.

Importantly, as social mores change, so too may considerations about the cost-benefit of including particular entities in the nosology. Premenstrual dysphoric disorder (PMDD), formerly known as late luteal phase dysphoric disorder, is well described in the psychiatric literature. There is clear evidence that specific psychobiological mechanisms are altered in those with this condition, and that those with this condition may benefit from medical treatments (Epperson et al., 2012 ). Still, this entity was not included in DSM-IV, as concerns were raised that the diagnosis would impact negatively on women, confirming stereotypes that they had less ability to fulfil professional obligations (Zachar & Kendler, 2015 ). In DSM-5, perhaps partly because of advances in our understanding of and treatment of PMDD, and perhaps partly because of continued advances in gender parity, PMDD was included in the manual. Judgments about the inclusion of entities in the nosology may need to weigh up responsibilities to patients v. responsibilities to society as a whole.

Taken together, these exemplars may help shed light on key conceptual issues involved in including a proposed entity in the classification.

One set of conceptual issues surround the notion of ‘harm’. Harm refers to suffering or disadvantage associated with a particular condition, and is operationalized with the ‘clinical criterion’ of DSM-5 using the phrase ‘significant distress and/or impairment’. It has often been emphasized, including by DSM-5, that this criterion is ‘fuzzy’, and also that not all distress/impairment points to a mental disorder. However, our exemplars indicate a number of additional complexities.

First, decisions about the introduction of new entities into the nosology need to balance the harm to the individual with harm to society. This is seen in the discussion of PCD and PMDD. The introduction of PCD has significant potential for societal harm, and the proposal to introduce this disorder was rejected. While there were concerns about such harm for PMDD, societal changes have significantly mitigated these concerns, and the proposal to introduce this disorder was accepted. Furthermore, putative PCDs are relatively rare and PMDD relatively common, so the possibility of clinical benefit to those affected is greater for the latter (Hartlage, Breaux, & Yonkers, 2014 ; Robinson & Ismail, 2015 ; Thornton, 2010 ; Wollert, 2011 ). Second, there may be significant debate about the extent to which harm is due to the failure of society to accommodate differences. This is seen in debates around the inclusion of homosexual and gender dysphoria in the nosology. In the former case, exclusion was agreed upon, while in the latter case inclusion was advocated.

While the concept of ‘harm’ is a useful one for defining mental disorder, when new entities are proposed in the future, it will be important to consider, for some of them, more sharply, the issue of individual v. societal harm, as well as the issue of societal accommodation. Notably, our exemplars seem to indicate that profiles of harm may change over time as societies change. Although this is seen in only a very small number of exemplars, this means that we cannot provide future decision-makers with algorithmic advice about what proposal to accept or reject across the board. Just as the clinical criterion requires careful clinical judgment, so in the case of these disorders, decisions will require careful practical judgment, that weighs up a range of relevant considerations.

The second set of conceptual issues is those concerning the notion of ‘dysfunction’. In some medical disorders there is persuasive evidence of biological dysfunction (e.g. in progeria and in schizophrenia, neurogenetic mechanisms are causally linked to distressing and impairing symptoms). However, in many mental conditions, causal mechanisms are poorly understood, and psychobiological dysfunction is inferred on the basis of crude markers such as the severity of symptoms and the extent of associated distress and impairment (e.g. in mild cognitive impairment and in social anxiety disorder). Furthermore, our exemplars point to additional considerations.

In particular, in some cases of putative mental disorder, even though there are symptoms, as well as associated distress and impairment, there are still reasons to doubt the presence of underlying psychobiological dysfunction. First, the symptoms may simply reflect apparently normal processes, such as memory loss with age, or bereavement symptoms after a loss. Second, the symptoms may represent an understandable response to particular circumstances, other than those in Table 3 , criterion C. Suicidal ideation, for example, may be reasonable under certain circumstances. Thus, judgments about dysfunction, again, require careful practical judgment, weighing up a range of relevant considerations.

While the concept of ‘dysfunction’ is a useful one for conceptualizing mental disorders, when new entities are proposed in the future, it would be ideal to have more sharply defined indicators of dysfunction. Symptom severity, excessiveness, and duration may be helpful in indexing dysfunction (e.g. pointing to hypersexuality, or obsessional jealousy), but they are rough indicators that run the risk of relying on a statistical definition of dysfunction. At the same time, it is notable how rarely molecular evidence, per se , is able to index dysfunction; crucially, biological difference does not point to dysfunction .

The third set of conceptual issues relates to the type and extent of data required to reach conclusions about harm and dysfunction. In our proposed DSM-5 definition of mental disorder, we emphasized the importance of evidence for diagnostic validity and clinical utility. Diagnostic validity is supported, in part, by data that point to the involvement of specific etiological mechanisms; such data support assertions that psychobiological dysfunction is present and can be addressed by health interventions. Clinical utility is supported, in part, by data indicating that clinical assessment and intervention will be helpful; such data support assertions that harm is present and can be diminished. These issues are not listed in the DSM-5 text defining mental disorders, but our exemplars suggest that they are useful considerations.

Thus, across different proposals for disorders, there have been differences in the type and extent of data that support diagnostic validity and clinical utility. This is apparent in discussions of behavioral addictions, APS, and simple type schizophrenia. In behavioral addictions, some entities (e.g. gambling) have a great deal of data supporting diagnostic validity and clinical utility, while others (e.g. gaming) have fewer supporting data. In the case of simple type schizophrenia there are insufficient data to demonstrate diagnostic validity, and in the case of APS, there are insufficient data to demonstrate clinical utility.

It is notable that most discussions of the definition of mental disorders focus on conceptual issues and are therefore quite different from a data-oriented approach to the validation of entities, once they are considered to be disorders. It may be useful to incorporate explicitly the importance of a validation-oriented approach into conceptual discussions. Some in the field expect that once internet gaming gathers more high-quality validity and utility data, it too will be accepted as a disorder. Our view is that the field should recognize the potential importance of evidence of diagnostic validity and clinical utility in the definition of a mental disorder, and that future revisions further clarify the type and extent of data needed to support such judgments.

In summary, this paper has taken an exemplar-based approach to the question of defining mental disorders. We had hoped to extract a set of practical guidelines that future nosologists could draw on when discussing proposals for new entities. The conceptual issues that emerge from our exemplars are, however, complex, indicating that any future proposal will need to be assessed on its particular merits, using practical judgment. Nevertheless, several proposals for the field emerged. First, while harm is useful for defining mental disorder, some proposed entities may require careful consideration of individual v. societal harm, as well as of societal accommodation. Second, while dysfunction is useful for conceptualizing mental disorders, the field would benefit from developing more sharply defined indicators of dysfunction. Third, it would be useful to incorporate evidence of diagnostic validity and clinical utility into the definition of a mental disorder and to further clarify the type and extent of data needed to support such judgments.

Financial support

This research received no specific grant from any funding agency, commercial or not-for-profit sectors. However, Dan J Stein is funded by the South African Medical Research Council.

Conflict of interest

Dan J Stein has received support from Johnson & Johnson, Lundbeck, Servier, and Takeda for work unrelated to the topic of this manuscript, Andrea C Palk and Kenneth S Kendler have no conflicts of interest.

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Mental Health Essay

Introduction

Mental health, often overshadowed by its physical counterpart, is an intricate and essential aspect of human existence. It envelops our emotions, psychological state, and social well-being, shaping our thoughts, behaviors, and interactions. With the complexities of modern life—constant connectivity, societal pressures, personal expectations, and the frenzied pace of technological advancements—mental well-being has become increasingly paramount. Historically, conversations around this topic have been hushed, shrouded in stigma and misunderstanding. However, as the curtains of misconception slowly lift, we find ourselves in an era where discussions about mental health are not only welcomed but are also seen as vital. Recognizing and addressing the nuances of our mental state is not merely about managing disorders; it's about understanding the essence of who we are, how we process the world around us, and how we navigate the myriad challenges thrown our way. This essay aims to delve deep into the realm of mental health, shedding light on its importance, the potential consequences of neglect, and the spectrum of mental disorders that many face in silence.

Importance of Mental Health

Mental health plays a pivotal role in determining how individuals think, feel, and act. It influences our decision-making processes, stress management techniques, interpersonal relationships, and even our physical health. A well-tuned mental state boosts productivity, creativity, and the intrinsic sense of self-worth, laying the groundwork for a fulfilling life.

Negative Impact of Mental Health

Neglecting mental health, on the other hand, can lead to severe consequences. Reduced productivity, strained relationships, substance abuse, physical health issues like heart diseases, and even reduced life expectancy are just some of the repercussions of poor mental health. It not only affects the individual in question but also has a ripple effect on their community, workplace, and family.

Mental Disorders: Types and Prevalence

Mental disorders are varied and can range from anxiety and mood disorders like depression and bipolar disorder to more severe conditions such as schizophrenia.

• Depression: Characterized by persistent sadness, lack of interest in activities, and fatigue.
• Anxiety Disorders: Encompass conditions like generalized anxiety disorder, panic attacks, and specific phobias.
• Schizophrenia: A complex disorder affecting a person's ability to think, feel, and behave clearly.

The prevalence of these disorders has been on the rise, underscoring the need for comprehensive mental health initiatives and awareness campaigns.

Understanding Mental Health and Its Importance

Mental health is not merely the absence of disorders but encompasses emotional, psychological, and social well-being. Recognizing the signs of deteriorating mental health, like prolonged sadness, extreme mood fluctuations, or social withdrawal, is crucial. Understanding stems from awareness and education. Societal stigmas surrounding mental health have often deterred individuals from seeking help. Breaking these barriers, fostering open conversations, and ensuring access to mental health care are imperative steps.

Conclusion: Mental Health

Mental health, undeniably, is as significant as physical health, if not more. In an era where the stressors are myriad, from societal pressures to personal challenges, mental resilience and well-being are essential. Investing time and resources into mental health initiatives, and more importantly, nurturing a society that understands, respects, and prioritizes mental health is the need of the hour.

• World Leaders: Several influential personalities, from celebrities to sports stars, have openly discussed their mental health challenges, shedding light on the universality of these issues and the importance of addressing them.
• Workplaces: Progressive organizations are now incorporating mental health programs, recognizing the tangible benefits of a mentally healthy workforce, from increased productivity to enhanced creativity.
• Educational Institutions: Schools and colleges, witnessing the effects of stress and other mental health issues on students, are increasingly integrating counseling services and mental health education in their curriculum.

In weaving through the intricate tapestry of mental health, it becomes evident that it's an area that requires collective attention, understanding, and action.

  Short Essay about Mental Health

Mental health, an integral facet of human well-being, shapes our emotions, decisions, and daily interactions. Just as one would care for a sprained ankle or a fever, our minds too require attention and nurture. In today's bustling world, mental well-being is often put on the back burner, overshadowed by the immediate demands of life. Yet, its impact is pervasive, influencing our productivity, relationships, and overall quality of life.

Sadly, mental health issues have long been stigmatized, seen as a sign of weakness or dismissed as mere mood swings. However, they are as real and significant as any physical ailment. From anxiety to depression, these disorders have touched countless lives, often in silence due to societal taboos.

But change is on the horizon. As awareness grows, conversations are shifting from hushed whispers to open discussions, fostering understanding and support. Institutions, workplaces, and communities are increasingly acknowledging the importance of mental health, implementing programs, and offering resources.

In conclusion, mental health is not a peripheral concern but a central one, crucial to our holistic well-being. It's high time we prioritize it, eliminating stigma and fostering an environment where everyone feels supported in their mental health journey.

Frequently Asked Questions

• What is the primary focus of a mental health essay?

Answer: The primary focus of a mental health essay is to delve into the intricacies of mental well-being, its significance in our daily lives, the various challenges people face, and the broader societal implications. It aims to shed light on both the psychological and emotional aspects of mental health, often emphasizing the importance of understanding, empathy, and proactive care.

• How can writing an essay on mental health help raise awareness about its importance?

Answer: Writing an essay on mental health can effectively articulate the nuances and complexities of the topic, making it more accessible to a wider audience. By presenting facts, personal anecdotes, and research, the essay can demystify misconceptions, highlight the prevalence of mental health issues, and underscore the need for destigmatizing discussions around it. An impactful essay can ignite conversations, inspire action, and contribute to a more informed and empathetic society.

• What are some common topics covered in a mental health essay?

Answer: Common topics in a mental health essay might include the definition and importance of mental health, the connection between mental and physical well-being, various mental disorders and their symptoms, societal stigmas and misconceptions, the impact of modern life on mental health, and the significance of therapy and counseling. It may also delve into personal experiences, case studies, and the broader societal implications of neglecting mental health.

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The Importance of Mental Health

Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Akeem Marsh, MD, is a board-certified child, adolescent, and adult psychiatrist who has dedicated his career to working with medically underserved communities.

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Risk Factors for Poor Mental Health

Signs of mental health problems, benefits of good mental health, how to maintain mental health and well-being.

Your mental health is an important part of your well-being. This aspect of your welfare determines how you’re able to operate psychologically, emotionally, and socially among others.

Considering how much of a role your mental health plays in each aspect of your life, it's important to guard and improve psychological wellness using appropriate measures.

Because different circumstances can affect your mental health, we’ll be highlighting risk factors and signs that may indicate mental distress. But most importantly, we’ll dive into all of the benefits of having your mental health in its best shape.

Mental health is described as a state of well-being where a person is able to cope with the normal stresses of life. This state permits productive work output and allows for meaningful contributions to society.

However, different circumstances exist that may affect the ability to handle life’s curveballs. These factors may also disrupt daily activities, and the capacity to manage these changes. 

The following factors, listed below, may affect mental well-being and could increase the risk of developing psychological disorders .

Childhood Abuse

When a child is subjected to physical assault, sexual violence, emotional abuse, or neglect while growing up, it can lead to severe mental and emotional distress.

Abuse increases the risk of developing mental disorders like depression, anxiety, post-traumatic stress disorder, or personality disorders.

Children who have been abused may eventually deal with alcohol and substance use issues. But beyond mental health challenges, child abuse may also lead to medical complications such as diabetes, stroke, and other forms of heart disease.

The Environment

A strong contributor to mental well-being is the state of a person’s usual environment . Adverse environmental circumstances can cause negative effects on psychological wellness.

For instance, weather conditions may influence an increase in suicide cases. Likewise, experiencing natural disasters firsthand can increase the chances of developing PTSD. In certain cases, air pollution may produce negative effects on depression symptoms.  

In contrast, living in a positive social environment can provide protection against mental challenges.

Your biological makeup could determine the state of your well-being. A number of mental health disorders have been found to run in families and may be passed down to members.

These include conditions such as autism , attention deficit hyperactivity disorder , bipolar disorder , depression , and schizophrenia .

Your lifestyle can also impact your mental health. Smoking, a poor diet , alcohol consumption , substance use , and risky sexual behavior may cause psychological harm. These behaviors have been linked to depression.

When mental health is compromised, it isn’t always apparent to the individual or those around them. However, there are certain warning signs to look out for, that may signify negative changes for the well-being. These include:

• A switch in eating habits, whether over or undereating
• A noticeable reduction in energy levels
• Being more reclusive and shying away from others
• Feeling persistent despair
• Indulging in alcohol, tobacco, or other substances more than usual
• Experiencing unexplained confusion, anger, guilt, or worry
• Severe mood swings
• Picking fights with family and friends
• Hearing voices with no identifiable source
• Thinking of self-harm or causing harm to others
• Being unable to perform daily tasks with ease

Whether young or old, the importance of mental health for total well-being cannot be overstated. When psychological wellness is affected, it can cause negative behaviors that may not only affect personal health but can also compromise relationships with others. 

Below are some of the benefits of good mental health.

A Stronger Ability to Cope With Life’s Stressors

When mental and emotional states are at peak levels, the challenges of life can be easier to overcome.

Where alcohol/drugs, isolation, tantrums, or fighting may have been adopted to manage relationship disputes, financial woes, work challenges, and other life issues—a stable mental state can encourage healthier coping mechanisms.

A Positive Self-Image

Mental health greatly correlates with personal feelings about oneself. Overall mental wellness plays a part in your self-esteem . Confidence can often be a good indicator of a healthy mental state.

A person whose mental health is flourishing is more likely to focus on the good in themselves. They will hone in on these qualities, and will generally have ambitions that strive for a healthy, happy life.

Healthier Relationships

If your mental health is in good standing, you might be more capable of providing your friends and family with quality time , affection , and support. When you're not in emotional distress, it can be easier to show up and support the people you care about.

Better Productivity

Dealing with depression or other mental health disorders can impact your productivity levels. If you feel mentally strong , it's more likely that you will be able to work more efficiently and provide higher quality work.

Higher Quality of Life

When mental well-being thrives, your quality of life may improve. This can give room for greater participation in community building. For example, you may begin volunteering in soup kitchens, at food drives, shelters, etc.

You might also pick up new hobbies , and make new acquaintances , and travel to new cities.

Because mental health is so important to general wellness, it’s important that you take care of your mental health.

To keep mental health in shape, a few introductions to and changes to lifestyle practices may be required. These include:

• Taking up regular exercise
• Prioritizing rest and sleep on a daily basis
• Trying meditation
• Learning coping skills for life challenges
• Keeping in touch with loved ones
• Maintaining a positive outlook on life

Another proven way to improve and maintain mental well-being is through the guidance of a professional. Talk therapy can teach you healthier ways to interact with others and coping mechanisms to try during difficult times.

Therapy can also help you address some of your own negative behaviors and provide you with the tools to make some changes in your own life.

A Word From Verywell

Your mental health state can have a profound impact on all areas of your life. If you're finding it difficult to address mental health concerns on your own, don't hesitate to seek help from a licensed therapist .

World Health Organization. Mental Health: Strengthening our Response .

Lippard ETC, Nemeroff CB. The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders . Am J Psychiatry . 2020;177(1):20-36. doi:10.1176/appi.ajp.2019.19010020

 Helbich M. Mental Health and Environmental Exposures: An Editorial. Int J Environ Res Public Health . 2018;15(10):2207. Published 2018 Oct 10. doi:10.3390/ijerph15102207

Helbich M. Mental Health and Environmental Exposures: An Editorial. Int J Environ Res Public Health . 2018;15(10):2207. Published 2018 Oct 10. doi:10.3390/ijerph15102207

National Institutes of Health. Common Genetic Factors Found in 5 Mental Disorders .

Zaman R, Hankir A, Jemni M. Lifestyle Factors and Mental Health . Psychiatr Danub . 2019;31(Suppl 3):217-220.

Medline Plus. What Is mental health? .

National Alliance on Mental Health. Why Self-Esteem Is Important for Mental Health .

By Elizabeth Plumptre Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Mental Health, Substance Use, and Wellbeing in Higher Education: Supporting the Whole Student (2021)

Chapter: 1 introduction, 1 introduction.

Postsecondary students, from those attending community colleges to professional and graduate students, are reporting rising rates of anxiety, depression, suicidal thoughts, trauma, and substance use (see Box 1-1 ) ( Xiao et al., 2017 ). 1 Many undergraduate students experience the onset of mental health and substance use problems or an exacerbation of their symptoms during this critical developmental stage ( Pedrelli et al., 2015 ). These increases call for substantial improvements in how the nation’s institutions of higher education engage with students, and for institutions to recognize how their policies, practices, and cultures can affect and support student mental health 2 and wellbeing more broadly ( Posselt, 2018b ). Treating mental illness at this stage in an individual’s development is key to lessening the potential for chronic mental conditions. More purposeful engagement by postsecondary institutions can help ameliorate some of the stresses unique to higher education that go beyond, for example, just being a young adult, veteran, or working adult returning to campus.

While mental health and substance use problems have increased significantly over the past decades, there is now heightened awareness about how the crises currently disrupting American life are exacerbating these problems. The COVID-19

___________________

1 Much of the information on the incidence of mental health and substance use problems among students comes from self-reports and not actual diagnoses. Self-report data can be inaccurate and may not in fact reflect well the true incidence of those issues among students in higher education ( Dang et al., 2020 ). Chapter 6 discusses research needed to address this limitation.

2 The committee has chosen to use the term “mental health” to refer collectively to mental health, the absence of or, at least, low levels of substance use, and wellbeing, and the term “mental illness” to refer to diagnosed, serious mental health problems such as depression, bipolar disorder, and anxiety disorder.

pandemic is one. Institutions of higher education have closed campuses, moved instruction online, and mandated physical distancing. This, in turn, has caused substantial disruptions in the lives of the nation’s college students, including loss of income, anxieties about their future educational and job prospects, and disconnection from the social interactions that are a normal part of college and young adult life. Indeed, a Kaiser Family Foundation survey conducted during the spring 2020 outbreak found that 45 percent of adults believed the pandemic affected their mental health, and 19 percent reported that the pandemic had a major effect on it ( Kirzinger et al., 2020 ; Panchal et al., 2020 ). A weekly survey conducted by Mental Health America found a 19 percent increase in screening for clinical anxiety was already occurring during the first weeks of February and a further 12 percent increase was seen in the first two weeks of March ( MHA, 2020a ). The National Institute on Drug Abuse has issued an alert that the pandemic could hit some populations with substance use disorders particularly hard ( NIDA, 2020d ). According to Kaiser Family Foundation researchers, “the pandemic is likely to have both long- and short-term implications for mental health and substance use. Those with mental illness and substance use disorders pre-pandemic, and those newly affected, will likely require mental health and substance use services” ( Panchal et al., 2020 ).

Surveys administered later in the pandemic have suggested these same trends are present at the same or even higher levels in college students (see Box 1-2 ) ( HMN and ACHA, 2020 ). An April 2020 survey by the American Council of Education found that 41 percent of university presidents ranked student mental health concerns as one of the five most pressing issues facing their institutions ( Turk et al., 2020a ). In addition, roughly 1,700 respondents to another survey by Active Minds said the pandemic negatively affected their mental health and 20 percent said their mental health had significantly worsened during the pandemic ( Active Minds, 2020 ). More than half of the students surveyed said they would not know where to go if they or someone they knew needed professional mental health services immediately. The rise in the prevalence of mental health problems is not unique to college student populations; the prevalence is rising in adolescent and young adult populations overall.

The second major crisis currently afflicting American life is the economic turmoil that has accompanied the COVID-19 outbreak. Colleges and universities are facing unprecedented financial challenges resulting from the loss of tuition revenues, uncertainty about future enrollment, and the costs of preparing their campuses to allow students, faculty, and staff to return safely, or absent that, preparing to deliver coursework online ( Startz, 2020 ). Faculty, staff, and students alike are experiencing loss of work and wages, which also increase the risks of experiencing mental health and substance use problems. This may be particularly true for students coming from communities of color or lower socioeconomic backgrounds, whom the pandemic has affected disproportionately.

Finally, the nation is facing a third crisis with significant effects on the physical and mental health of students of color and other historically underrepresented groups highlighted by the mass demonstrations and calls for racial justice following the murders of George Floyd, Breonna Taylor, and Ahmaud Arbery. In response to these murders, institutions of higher education, along with many other institutions and structures in our nation, have a growing recognition of the work that must be done to address systemic racism and dismantle inequities. The national energy to address racism and racial disparities raises the imperative to address issues that disproportionately affect students of color and those from other underserved populations so that all students can thrive during and after their years in higher education.

STUDENT WELLBEING IS FOUNDATIONAL FOR SUCCESS

The concept of wellbeing, according to the Centers for Disease Control and Prevention (CDC), refers to “the presence of positive emotions and moods (e.g., contentment or happiness), the absence of negative emotions (e.g., depression or anxiety), satisfaction with life, fulfillment, and positive functioning” ( Andrews and Withey, 1976 ; CDC, 2018 ; Diener, 2000 ). Student wellbeing is foundational to academic success.

The CDC and other leading public health organizations argue that wellbeing has mental, emotional, physical, spiritual, social, financial, and other dimensions that, individually and collectively, impact a variety of outcomes of concern to colleges and universities. Student wellbeing is about more than just having happy students: a large body of research has shown that mental health challenges significantly affect academic achievement and graduation rates in postsecondary education ( Mojtabai et al., 2015 ).

Just as wellbeing is a foundational element for students’ success in day-today life, it is equally important for degree completion. However, judging from the figures cited in Box 1-1 , far too many postsecondary students are not experiencing a level of wellbeing that will enable them to thrive in an academic setting and reach their full potential.

While dealing with stress is a normal part of life, for some students stress can adversely affect their physical, emotional, and psychological health ( Hartley, 2011 ; Shankar and Park, 2016 ). Moreover, studies have found that dropout rates for students with a diagnosable mental health problem range from 43 percent ( Breslau et al., 2008 ) to as high as 86 percent ( Collins and Mowbray, 2005 ). This risk is particularly relevant for institutions of higher education given that adolescence and early adulthood is when most mental illnesses are first experienced ( American Psychiatric Association, 2018 ). Mental health issues may appear in children and adolescents. A literature review of related studies found evidence of mental health problems in adolescents, with increases being more prevalent in girls than boys ( Haidt and Twenge, 2019 ). Thus, many undergraduate and

graduate students arrive on campus with an undiagnosed mental illness that becomes salient during their years as students.

Addressing the Mental Health Challenges of Students

In addition to students who may develop mental health challenges during their time in postsecondary education, growing numbers of students arrive on campus with a current mental health or substance use problem or having experienced significant trauma in their lives that intensifies the stress response. Managing that stress response can sap attentional energy—the “bandwidth” necessary for academic success—negatively affect their physical, emotional, and psychological wellbeing ( Verschelden, 2017 ). Stress, such as the isolation students are experiencing during the COVID pandemic, can be a major factor causing relapse and should be factored into plans for dealing with substance use, particularly in the post-pandemic period of full reopening.

Although it is a time of emotional and intellectual growth, pursuing a postsecondary education, whether at a community college, baccalaureate institution, or in a graduate or professional degree program, can be a stressful and challenging experience for many students and negatively affect wellbeing ( Larcombe et al., 2016 ; Liu et al, 2019 ).

This can be particularly true for students from historically excluded groups such as students who are Black, Indigenous, and people of color, first-generation students; students who graduate from under-resourced high schools, non-native English speakers; students with disabilities; and sexual and gender minorities. While education has been characterized as the great equalizer, institutions of higher education have hardly been immune from the systemic inequalities and racism that have constrained equal opportunity, adding further stressors to students’ academic resilience. Awareness of how students experience stressors within educational environments is critical, whether it is in activating effects of past trauma, revealing undiagnosed mental health issues, or navigating social and institutional mechanisms of privilege and equity. In the general population, studies have indicated that, for some underrepresented minorities, mental illness can be seen as highly stigmatizing and can result in lower treatment-seeking, depending on the context ( Gary, 2005 ; NMHA, 1998 ; Ward et al., 2014). However, this has not been found to be the case for college students of color. In a study examining enrollment and counseling center service utilization data at 66 universities, Hayes et al. (2011) found no difference in utilization of counseling services between ethnic minority students and European American students. In fact, the authors found that “among students of color, utilization of campus counseling services was predicted by greater psychological distress, less family support, and a history of previous psychological problems.” The authors also found that the ethnic composition of the student body, as well as the ethnic composition of the counseling center staff, predicted the likelihood that students would seek counseling

services. For example, the higher the percentage of African American therapists at a university counseling center, the greater the percentage of African American students who sought services. Some programs that address these issues, including the stigma of mental health for all students as well as underrepresented minority students, are described in Chapter 3 .

Results from the Healthy Minds study have shown that across all types of postsecondary institutions and fields of study, students reporting mental health problems were twice as likely as other students to drop out of school before completing their degree ( Eisenberg, Golberstein, and Gollust, 2009 ). Even for those students who do graduate, mental health problems can be associated with breaks in their education ( Arria et al., 2013 ), longer times to graduation, and lower grade point averages. In addition, a Microsoft/Economist Intelligence Unit survey found that 79 percent of postsecondary educators believe that emotional wellbeing is a “very” or “extremely” important factor in student academic success. Seventy percent of those surveyed believed that emotional wellbeing has become more important for student success than when they started their careers ( Green, 2019 ).

Further along in their intellectual and career development, graduate and professional students’ mental health are growing concerns, too. It has been reported that the rates of mental health problems in graduate students is six times that of the general population ( Evans et al., 2018 ). A 2014 report from the University of California, Berkeley, found that 43 to 46 percent of bioscience graduate students reported that they were depressed ( Panger, Tryon, and Smith, 2014 ). A more recent survey of nearly 2,300 doctoral and master’s degree students across all fields found that graduate students were four times more likely to suffer from depression and anxiety than a member of the general public in the same age group ( Evans et al., 2018 ). Greater than 40 percent of graduate students surveyed had moderate to severe anxiety, and nearly 40 percent had moderate to severe depression. Similarly, a 2014 survey of medical students found that 58 percent screened positive for depression and nearly 75 percent reported a high or intermediate level of emotional exhaustion ( Dyrbye et al., 2014 ). In other survey data from 89 institutions, there was considerable variation in the rates of depression and anxiety by field of study and social identities in the graduate and professional student population, suggesting the need for targeted attention and efforts at this level ( Posselt, 2016 ). See Box 1-3 for key definitions related to mental health and substance use.

THE CASE FOR SHARED RESPONSIBILITY

The goal of postsecondary education is to equip students with the knowledge and degree credentials that will enable them to be productive members of society. Hence, it will undoubtedly further an institution’s academic mission to increase student degree completion rates and foster a higher level of student performance and learning via a campus-wide focus on student mental health and wellbeing. One recent study found that 25 percent of students who dropped out of college

with a grade point average less than 3.0 screened positive for at least one mental illness. Another study showed that some 30 percent of college students suffering from depression will drop out of school ( Douce and Keeling, 2014 ). For students from historically underserved groups who may have been underdiagnosed, there may be higher levels of undetected psychiatric problems that increase students’ risk of developing mental health problems while on campus. Attending to the multifactorial dynamics in mental health and wellbeing requires paying attention to the interplay between historical factors in psychiatric diagnosis by race and ethnicity ( Chen et al., 2019 ).

A report from the American Council on Education emphasizes the point, saying, “the connection between mental health issues and student retention, particularly for students from historically underserved groups, has implications for the

economic wellbeing of students and institutions alike. Specifically, the negative effects of mental health and substance use problems on student retention suggest that institutional investments in student mental health are likely to generate both increased tuition revenues for institutions and higher earnings for students who attain a college degree” ( Lipson, Lattie, and Eisenberg, 2019 ). As this report discusses in Chapter 5 , investing resources to address student mental health issues and foster student wellbeing can have a sizable return on investment, both for the institution and society at large ( Eisenberg, Golberstein, and Hunt, 2009 ). Additional motivations for postsecondary institutions to promote student wellbeing include transient and repeated relocation away from natural support systems, a rising awareness that higher education’s own culture can compromise wellbeing, and evidence that healthier academic communities are more productive and creative.

Virtually every institution of higher education provides some sort of mental health counseling, typically through a counseling and psychological services center. This institutionalized function, though usually underfunded to provide all of the mental health needs for matriculating students, can lead college and university leaders to assume that simply bolstering their counseling centers could be an acceptable solution to mental health problems that today’s students face. It is the committee’s judgment, however, that counseling centers cannot and should not be expected to solve these problems alone, given that the factors and forces affecting student wellbeing go well beyond the purview and resources that counseling centers can bring to bear. Moreover, the committee believes institutions of higher education need to tackle two significant challenges. First, they must address the challenges arising from the increasing incidence of mental health and substance use issues among students in postsecondary education. In addition, both the institutions and their faculty and staff need to address the issues within higher education institutions themselves that contribute to this increasing incidence. A primary factor in dealing with these issues is the need for institutions to address the inadequate resources currently assigned in most places to counseling centers after decades of mental health interventions designed to identify and refer students to treatment.

Another driver for colleges and universities to improve the mental health and substance use services they offer is accreditation. The Department of Education delegated to accreditation organizations the responsibility to evaluate and certify that colleges and universities are providing quality education and value to the public. In fact, accreditation approval is a key factor in universities and colleges qualifying for federal funding for research and education. These accreditation organizations, such as the Higher Learning Commission, several regional accrediting bodies, and others, have recently strengthened their standards for higher education institutions to track and improve student outcomes in the areas of retention, completion rates, job placement, and graduate school placement, all outcomes that are negatively affected when student mental health issues are not addressed. For example, the new 2020 Higher Learning Commission

accreditation standards state, “the institution pursues educational improvement through goals and strategies that improve retention, persistence and completion rates in its degree programs (Standard 4.C.)” and “the institution implements its plans to systematically improve its operations and student outcomes (Standard 5.C.6).” 3

An “all hands” approach, one that emphasizes shared responsibility and a holistic understanding of what it means in practice to support students, is needed if institutions of higher education are to intervene from anything more than a reactive standpoint. Creating this systemic change requires that institutions examine the entire culture and environment of the institution and accept more responsibility for creating learning environments where a changing student population can thrive. Specifically, creating conditions that support mental health and helping students deal with mental health and substance use issues when they arise, including helping them access adequate professional help, requires mobilizing commitment and actions by the entire institution. The committee strongly believes that only through such a multi-pronged strategy (see Chapter 5 ) can our nation’s institutions of higher education create a supportive environment that will benefit everyone, including faculty and staff who must be active participants in this effort.

In addition to being aware of the ways in which they might exacerbate conditions that undermine student health, faculty have an underacknowledged role in promoting student mental health. This is not to say that faculty should become professional counselors or therapists. They are front-line workers, however, and therefore should have basic training in identifying and speaking with students who may benefit from an intervention for a mental health concern or other stressor, such as food or housing insecurity. Faculty should know about the main offices on campus that provide students with support for basic needs and mental health, as well as those that offer wellbeing programs. Faculty also need training to understand how their own teaching, mentoring, supervision, and lab leadership affect their student’s mental health, and they need opportunities to develop skills and norms that improve their work in these areas ( NASEM, 2019b ). Again, faculty should not act in the place of trained counselors, but they do need to promote a healthy learning environment, recognize issues, empathize with students, and refer them to professionals who can help.

It is the responsibility of the entire university community (administrators, faculty, and staff)—not solely students and those who treat them—to consider student perspectives and incorporate their suggestions to create an environment of health, safety, inclusiveness, respect, and wellbeing.

Institutional leaders should strive toward wellness of academia as a whole, rather than just focusing on students. The culture of academia can be a hostile

3 The criteria for accreditation from the Higher Learning Commission can be found at https://www.hlcommission.org/Policies/revised-criteria-for-accreditation.html (accessed August 3, 2020).

environment for students and can create or exacerbate mental health issues. Institutional leadership must consider that asking students to change their own circumstances without institutional help is beyond what can be reasonably expected, particularly for students who come from historically marginalized or excluded populations.

Systemic racism in the United States has a major impact on students’ sense of safety, wellbeing, and mental health, particularly but not only for students of color. Although the impact of systemic racism on student wellbeing and mental health warrants an entirely separate study, the committee emphasizes that it is critical for institutions to examine the extent to which racism affects and threatens students and all other members of the academic community. Listening to the voices of students, staff, and professors who have been the target of racism is the only way to learn how pervasive it is. As a recent report notes, “racial trauma-informed leadership prioritizes listening, demonstrates empathy towards injustices and inequalities experienced by students of color, and creates and adapts resources that respond to their mental health needs” ( Steve Fund, 2020 ).

Institutions should look especially carefully at policies that affect the academic and social environment, including alcohol and other drug policies and policies on sexual harassment and assault, as well as those that govern student organizations such as fraternities and sororities and their off-campus venues.

In summary, to realize long-term, widescale improvements in student wellbeing, institutions should both improve their infrastructure to respond to needs that arise and improve the qualities of environments in which students already work and learn. They need to become more proactive and less reactive in ensuring a climate that promotes wellness for everyone on campus.

BACKGROUND OF THE REPORT

To understand how the culture of a given institution of higher education affects student wellbeing and can trigger student mental health problems or exacerbate existing ones, and to identify approaches that institutions can adopt to foster student wellbeing and help those students who are having difficulties, the National Academies of Sciences, Engineering, and Medicine launched an 18-month consensus study in June 2019. Under the auspices of the Board on Higher Education and Workforce, and in collaboration with the Health and Medicine Division, the National Academies appointed a committee of experts to examine the most current research and consider the ways that institutions of higher education, including community colleges, provide treatment and support for the mental health and wellbeing of undergraduate and graduate students in all fields of study. For the purposes of this report, the term mental health will be used to refer to mental health and emotional and behavioral issues. The term mental illness will be used

specifically in reference to diagnosed serious mental disorders, including depression, schizophrenia, bipolar disorder, or anxiety disorder.

By contrast, wellbeing is a holistic concept referring to both physical and mental health. Mental wellbeing includes a sense of personal safety and security, emotional support and connection, mechanisms to cope with stressors, and access to services when appropriate for short- and long-term care. The committee believes that institutions have a responsibility both to enhance the wellbeing of all students and to provide additional support to a subset of students with more severe emotional distress and mental illness.

The Statement of Task for the Committee on Supporting the Whole Student: Mental Health, Substance Abuse, and Wellbeing in Higher Education includes the following specific tasks:

• Identify and review programs, practices, resources, and policies that institutions of higher education have developed to treat mental health issues and to support wellbeing on campuses.
• Analyze the challenges that institutions face—including financial, cultural, and human resource obstacles and methods to address these challenges.
• Investigate factors related to the funding of and access to mental health services and support for student wellbeing, such as student academic performance and campus climate.
• Examine, to the extent possible, the relationship between student mental health, wellbeing, and rates of alcohol and drug use, and recommend ways in which institutions can address substance use and its effects on campus climate.
• Produce a consensus report with recommendations, as well as derivative products that will be broadly distributed on campuses, at professional society meetings, and in other venues.

Over the course of the 18-month study, the committee held two in-person and two virtual listening sessions with university leaders and administrators, counseling center directors and staff, researchers, and students on four campuses. Participants were asked to comment on the statement of task, share related research, describe mental health services on campus (location of offices, staff organization, and description of roles), and identify issues they saw as priorities in the field. Because a significant portion of the study took place during the height of the COVID-19 outbreak, the committee’s ability to meet and hold discussions in person and conduct information-gathering activities and listening sessions at institutions of various types and sizes and conferences was limited.

The committee also examined data from multiple federal agencies and national professional networks and associations and commissioned the following papers and literature reviews:

Miriam Akeju, “Behavioral Health of Students Identifying as Hispanic/Latinx at Colleges and Universities: Existing Data, Trends, and Best Practices for Prevention, Early Intervention and Treatment.”

Angie Barrall, “Substance Use Disorders: Literature Review and Research Analysis.”

Nicole Braun, “Mental Illness, Substance Use, and Wellness at Community Colleges in the US: Literature Review and Research Analysis.”

Susanna Harris, “A Review of Mental Health, Substance Abuse, and Well-being Resources for Students and a Review of Previous Report Recommendations in Higher Education.”

David Patterson Silver Wolf; Asher Blackdeer, A.; Beeler-Stinn, S.; & Van Schuyver, J., “Behavioral Health Trends of Students Enrolled at Historically Black College and Universities and Tribal Colleges and Universities.”

Finally, the committee commissioned an analysis by the Counseling Center of the University of Illinois at Urbana-Champaign of previously unpublished data on suicide rates from 2009 to 2018 at 13 campuses that are members of the Big Ten Counseling Centers, modeled on a similar study by Silverman el al., 1997. This analysis can be found in Appendix D .

In conducting its research and making its recommendations, the committee decided to craft its findings and recommendations in ways that apply across the diverse types of academic institutions, and, when possible, point out special circumstances unique to individual types of institutions. The committee also paid greater attention to educational levels and academic fields in which data on student mental health issues were available. The report, therefore, contains some information on graduate students and medical students but focuses primarily on undergraduate students. Even though the committee was asked to investigate mental health issues among Science, Technology, Engineering, Mathematics, and Medicine (STEMM) students where feasible, most of the data relevant to this study are not disaggregated by field. In any case, the issues of mental health, substance use, and wellbeing affect all students in all disciplines, as do the campus services provided to deal with them.

Although mental health issues affect students in all professional fields of study, the committee was explicitly asked by the study sponsors to focus on medical students. It has provided some information on medical students, although given the broad scope of the study, that information is necessarily brief. In its focus on medical students, the committee acknowledges that the mental health issues facing this population frequently also apply to other health professionals

and students pursuing other health degrees. These mental health issues have been exacerbated by the COVID-19 crisis, where all health professionals are facing front line stresses related to the diagnosis, treatment, and care of patients and have been found to be at higher risk of developing psychological distress and other mental health symptoms.

The committee’s approach was to make the majority of its recommendations suitable for all institutions and to point out exceptions to those recommendations where appropriate.

Again, the committee acknowledges that there are limited data available on the mental health of students disaggregated by field. This is unfortunate, as differences by field are likely. For example, authors of a study at California Polytechnic State University found that the university’s engineering students “suffer from certain mental health issues at a much higher rate than the average U.S. college student” ( Danowitz and Beddoes, 2018 ). Further research on fields and subfields may reveal additional information about the specific needs of that population.

DATA SOURCES AND CONSIDERATIONS

Data on mental health and substance use in students can be challenging to interpret for a number of reasons. These data are drawn from different groups of students, including those seeking mental health services in counseling centers, subjects of targeted surveys on specific problems, higher education students in general, and broader segments of an age-equivalent population in and outside academia. Also, multiple methods are used in data collection, and it is important to consider the varying strengths, limitations, and purposes of various measurement approaches.

Much of the information on the incidence of mental health and substance use problems among students is based on self-reports from general population surveys, not actual clinical evaluations. This approach has the advantage of drawing from entire student populations, regardless of contact with health services, but it is also subject to key limitations. Self-report surveys typically rely on brief screens that are correlated with but not equivalent to clinical evaluations, resulting in a certain proportion of false positives and false negatives, depending on the sensitivity and specificity of the screen. In addition, survey self-reports are vulnerable to nonresponse bias, in which systematic differences between survey respondents and nonrespondents may yield results that do not accurately represent the target population ( Dang et al., 2020 ). At the same time, self-reported screens are an economical method for collecting data from large populations, and they remain the predominant approach to estimating the prevalence of mental health conditions in psychiatric epidemiology research.

Data from clinical settings are drawn from students who use mental health services from a counseling center in order to be evaluated or receive treatment. These data have two major strengths: the potential to characterize the full

sub-population (by minimizing or eliminating nonresponse) and the ability to include assessments by clinicians instead of or in addition to self-reported symptoms. The key caveat for clinical data is that they are limited to those who use clinical services and therefore do not represent students who are not accessing those services.

No single data point, or source of data, is capable of conveying the complexity of mental health and substance use problems among students. Multiple approaches and methodologies provide contrasting angles on the same concept and contribute to a richer understanding of the issues. These different approaches need to be taken into account in forming conclusions about the prevalence of mental health and substance use issues in higher education. Chapter 6 describes some of the research needed to help address data limitations.

STRUCTURE OF THE REPORT

Recommendations in this report are directed at the various stakeholders in the U.S. postsecondary education enterprise, including federal and state policy makers and funders, institutions of higher education and their administrators and faculty, as well as the students that the system is intended to educate. The recommendations are intended to help the nation’s institutions of higher education provide guidance that enables all who work and learn within it to create an environment that supports student wellbeing, establishes a culture that destigmatizes mental health issues, and provides those students in need with the appropriate services and resources. At the same time, the committee recognizes that at least some of its recommendations will require funds and institutional capacities that many community colleges, universities, and graduate and medical schools currently lack. For this reason, the committee also includes recommendations for policy makers and funders of higher education to help academic institutions bridge gaps and build capacity for long-term improvement.

As has been the case with other recent reports from the National Academies, such as Graduate STEM Education for the 21st Century , The Science of Effective Mentorship in STEMM , Breaking Through: The Next Generation of Biomedical and Behavioral Sciences Researchers , and The Integration of the Humanities and Arts with Sciences, Engineering, and Medicine in Higher Education: Branches from the Same Tree , improving student wellbeing comes down to an imperative to change institutional culture. Absent culture change, the status quo will remain. It is the committee’s hope that this report will serve as a call to action to faculty members, deans, provosts, presidents, and other university administrators to address the policies and culture of the nation’s institutions of higher education that adversely affect students’ mental health and substance use.

Following this introductory chapter, the remainder of this report lays out the committee’s analysis of the current state of students and institutions regarding mental health, substance use, and wellbeing in Chapters 2 . Chapter 3 offers

mental health, substance use, and wellbeing approaches, resources, and programs provided to the general student population, and Chapter 4 covers services provided to students by licensed providers or in a clinical setting. Chapter 5 examines specific challenges and barriers to change and the opportunities to address them with evidence-based interventions. Chapter 5 also contains the report’s major recommendations. Chapter 6 provides a listing of major issues that require additional research if the recommendations in this report are to be fully effective once implemented.

Student wellbeing is foundational to academic success. One recent survey of postsecondary educators found that nearly 80 percent believed emotional wellbeing is a "very" or "extremely" important factor in student success. Studies have found the dropout rates for students with a diagnosed mental health problem range from 43 percent to as high as 86 percent. While dealing with stress is a normal part of life, for some students, stress can adversely affect their physical, emotional, and psychological health, particularly given that adolescence and early adulthood are when most mental illnesses are first manifested. In addition to students who may develop mental health challenges during their time in postsecondary education, many students arrive on campus with a mental health problem or having experienced significant trauma in their lives, which can also negatively affect physical, emotional, and psychological wellbeing.

The nation's institutions of higher education are seeing increasing levels of mental illness, substance use and other forms of emotional distress among their students. Some of the problematic trends have been ongoing for decades. Some have been exacerbated by the COVID-19 pandemic and resulting economic consequences. Some are the result of long-festering systemic racism in almost every sphere of American life that are becoming more widely acknowledged throughout society and must, at last, be addressed.

Mental Health, Substance Use, and Wellbeing in Higher Education lays out a variety of possible strategies and approaches to meet increasing demand for mental health and substance use services, based on the available evidence on the nature of the issues and what works in various situations. The recommendations of this report will support the delivery of mental health and wellness services by the nation's institutions of higher education.

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Mental Health Essay for Students and Children

500+ words essay on mental health.

Every year world mental health day is observed on October 10. It was started as an annual activity by the world federation for mental health by deputy secretary-general of UNO at that time. Mental health resources differ significantly from one country to another. While the developed countries in the western world provide mental health programs for all age groups. Also, there are third world countries they struggle to find the basic needs of the families. Thus, it becomes prudent that we are asked to focus on mental health importance for one day. The mental health essay is an insight into the importance of mental health in everyone’s life. 

Mental Health

In the formidable years, this had no specific theme planned. The main aim was to promote and advocate the public on important issues. Also, in the first three years, one of the central activities done to help the day become special was the 2-hour telecast by the US information agency satellite system. 

Mental health is not just a concept that refers to an individual’s psychological and emotional well being. Rather it’s a state of psychological and emotional well being where an individual is able to use their cognitive and emotional capabilities, meet the ordinary demand and functions in the society. According to WHO, there is no single ‘official’ definition of mental health.

Thus, there are many factors like cultural differences, competing professional theories, and subjective assessments that affect how mental health is defined. Also, there are many experts that agree that mental illness and mental health are not antonyms. So, in other words, when the recognized mental disorder is absent, it is not necessarily a sign of mental health. 

Get the huge list of more than 500 Essay Topics and Ideas

One way to think about mental health is to look at how effectively and successfully does a person acts. So, there are factors such as feeling competent, capable, able to handle the normal stress levels, maintaining satisfying relationships and also leading an independent life. Also, this includes recovering from difficult situations and being able to bounce back.  

Important Benefits of Good Mental Health

Mental health is related to the personality as a whole of that person. Thus, the most important function of school and education is to safeguard the mental health of boys and girls. Physical fitness is not the only measure of good health alone. Rather it’s just a means of promoting mental as well as moral health of the child. The two main factors that affect the most are feeling of inferiority and insecurity. Thus, it affects the child the most. So, they lose self-initiative and confidence. This should be avoided and children should be constantly encouraged to believe in themselves.

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Understanding Bipolar Disorder: An In-Depth Essay

Imagine living in a world where emotions oscillate between exhilarating highs and crippling lows. Where one moment, you feel invincible, and the next, you are engulfed in a darkness so profound it seems suffocating. Welcome to the complex and enigmatic realm of bipolar disorder.

At some point in our lives, we all experience fluctuations in our moods. However, for individuals with bipolar disorder, these mood swings are extreme, unpredictable, and can have devastating consequences. It is a mental health condition that possesses the power to disrupt lives, strain relationships, and challenge society’s understanding.

In this in-depth essay, we will delve into the intricate facets of bipolar disorder, unraveling its definition, prevalence, and impact. We will explore the different types of the disorder and investigate the causes and risk factors that contribute to its development.

Furthermore, we will examine the symptoms associated with bipolar disorder and the diagnostic criteria used to identify it. We will highlight the challenges faced by individuals with bipolar disorder and the effects this condition can have on personal relationships. Additionally, we will confront the societal stigma and misunderstandings that permeate the public’s perception of bipolar disorder.

Treatment and management play a critical role in the lives of those with bipolar disorder, and we will explore the medication options, therapeutic approaches, and lifestyle changes that can provide support and stability.

To navigate such a vast and complex topic, it is important to understand how to approach writing an essay on bipolar disorder. We will discuss strategies for choosing a focus, structuring your essay, addressing controversial topics, and providing reliable sources.

This essay aims to shed light on the intricacies of bipolar disorder, debunk myths, and promote understanding and empathy. By gaining knowledge and insights into this often-misunderstood condition, we can facilitate a more inclusive and compassionate society. Join us on this journey of discovery as we strive to comprehend the multifaceted nature of bipolar disorder.

Overview of Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is a chronic mental health condition that affects a person’s mood, energy levels, and ability to function effectively. It is characterized by extreme shifts in mood, ranging from manic episodes, where individuals experience heightened euphoria and energy, to depressive episodes, where they feel overwhelming sadness, hopelessness, and a lack of interest in activities.

What is Bipolar Disorder?

Bipolar disorder is a complex condition that involves various biological, genetic, and environmental factors. It affects approximately 2.8% of U.S. adults, according to the National Institute of Mental Health. The onset of bipolar disorder usually occurs in late adolescence or early adulthood, although it can manifest at any age.

During manic episodes, individuals may exhibit symptoms such as increased talkativeness, racing thoughts, impulsivity, inflated self-esteem, and a decreased need for sleep. They may engage in risky behaviors, such as excessive spending or substance abuse. On the other hand, depressive episodes are characterized by symptoms like persistent sadness, fatigue, sleep disturbances, difficulty concentrating, and thoughts of death or suicide.

Types of Bipolar Disorder

Bipolar disorder is further categorized into several subtypes:

1. Bipolar I Disorder: This is the most severe form of the illness, involving manic episodes lasting for at least seven days or requiring hospitalization. Depressive episodes lasting for two weeks or more often accompany these manic episodes.

2. Bipolar II Disorder: In this type, individuals experience recurring depressive episodes but have hypomanic episodes that are less severe than full-blown mania. These hypomanic episodes do not usually lead to significant impairment in functioning.

3. Cyclothymic Disorder: Cyclothymic disorder is a milder form of bipolar disorder where individuals have frequent, but less intense, mood swings. They experience hypomanic symptoms and depressive symptoms that persist for at least two years, with brief periods of stability.

Causes and Risk Factors

The exact cause of bipolar disorder is not fully understood. However, research suggests that a combination of genetic, biological, and environmental factors contribute to its development. Individuals with a family history of bipolar disorder or other mood disorders are at a higher risk.

Other factors that may influence the development of bipolar disorder include abnormal brain structure and function, neurotransmitter imbalances, hormonal imbalances, and high levels of stress. Substance abuse or traumatic experiences may also trigger the onset or exacerbation of symptoms.

Understanding the different types of bipolar disorder and the contributing factors can help demystify this complex condition. By recognizing the signs and seeking appropriate diagnosis and treatment, individuals with bipolar disorder can lead fulfilling lives and manage their symptoms effectively.

Symptoms and Diagnosis of Bipolar Disorder

Bipolar disorder is a complex mental health condition characterized by distinct symptoms that significantly impact an individual’s daily life. Accurate diagnosis of bipolar disorder is crucial to ensure appropriate treatment and support. In this section, we will explore common symptoms of bipolar disorder, the diagnostic criteria used for its identification, and how it is distinguished from other mental health conditions.

Common Symptoms of Bipolar Disorder

The symptoms of bipolar disorder can vary depending on the specific episode and its severity. During manic episodes, individuals often experience an intense euphoria, increased energy levels, and a heightened sense of self-esteem. They may engage in risky behavior, such as excessive spending or engaging in dangerous activities. Rapid speech, racing thoughts, and impulsivity are also commonly observed.

Conversely, depressive episodes are characterized by persistent feelings of sadness, hopelessness, and a loss of interest in previously enjoyed activities. Individuals may experience changes in appetite and sleep patterns, difficulties concentrating, and thoughts of self-harm or suicide. Fatigue, a lack of motivation, and a general feeling of emptiness are also common symptoms.

Diagnostic Criteria for Bipolar Disorder

To diagnose bipolar disorder, healthcare professionals refer to the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). According to the DSM-5, the presence of manic, hypomanic, and depressive episodes is necessary for a bipolar disorder diagnosis.

For a diagnosis of bipolar I disorder, an individual must have experienced at least one manic episode, lasting for a minimum of seven days or requiring immediate hospitalization. Depressive episodes may or may not occur alongside the manic episodes.

In bipolar II disorder, individuals experience at least one major depressive episode and at least one hypomanic episode, which is characterized by milder manic symptoms that do not cause significant impairment in functioning.

Cyclothymic disorder, a milder form of bipolar disorder, is diagnosed when an individual experiences numerous periods of hypomanic symptoms and depressive symptoms over a two-year period.

Distinguishing Bipolar Disorder from other Mental Health Conditions

Differentiating bipolar disorder from other mental health conditions can be challenging due to overlapping symptoms. Depression alone, for example, may resemble the depressive episodes experienced by individuals with bipolar disorder. However, bipolar disorder is distinguished by the presence of manic or hypomanic episodes, which are not present in unipolar depression.

Other conditions such as borderline personality disorder and attention-deficit/hyperactivity disorder (ADHD) may exhibit symptoms similar to bipolar disorder, further complicating the diagnostic process. Thorough evaluation by a mental health professional is essential to accurately differentiate bipolar disorder from other conditions and develop an appropriate treatment plan.

Understanding the symptoms and diagnostic criteria of bipolar disorder helps in early identification and intervention, leading to improved outcomes for individuals living with this complex condition. Seeking professional help and support is crucial for accurate diagnosis and developing an effective management plan to mitigate the impact of bipolar disorder on daily life.

Impact of Bipolar Disorder on Individuals and Society

Bipolar disorder not only affects the lives of individuals diagnosed with the condition but also has a significant impact on their personal relationships, daily functioning, and society as a whole. In this section, we will explore the effects of bipolar disorder on personal relationships, the challenges faced by individuals with the condition, and societal stigma and misunderstandings surrounding bipolar disorder.

Effects of Bipolar Disorder on Personal Relationships

Living with bipolar disorder can strain personal relationships. The extreme mood swings, impulsivity, and erratic behavior exhibited during manic episodes can be confusing and distressing for partners, family members, and friends. Loved ones may struggle to understand the sudden changes in mood and energy levels, leading to strained communication and emotional instability within the relationship.

During depressive episodes, individuals with bipolar disorder may withdraw from social interactions, isolate themselves, and have difficulty expressing their needs and emotions. This can result in feelings of loneliness and isolation, further impacting the dynamics of personal relationships.

Challenges Faced by Individuals with Bipolar Disorder

Individuals with bipolar disorder face numerous challenges that affect their daily lives. The unpredictability of mood swings can make it difficult to maintain stable employment or pursue educational goals. Managing relationships, parenting responsibilities, and financial stability may also become more challenging due to the episodic nature of the condition.

Additionally, the presence of comorbid conditions, such as anxiety disorders or substance abuse, further compounds the difficulties faced by individuals with bipolar disorder. The stigma associated with mental illness may also create barriers in accessing proper treatment and support, exacerbating the challenges they encounter.

Societal Stigma and Misunderstandings

Despite growing awareness and understanding of mental health, societal stigma and misunderstandings surrounding bipolar disorder still persist. Many people hold misconceptions that individuals with bipolar disorder are simply “moody” or “unstable.” Such stigmatization can lead to social exclusion, discrimination, and a reluctance to seek help.

Moreover, the portrayal of bipolar disorder in popular culture and media often exaggerates the extreme behaviors associated with the condition, further perpetuating misconceptions and reinforcing stereotypes. This portrayal not only contributes to societal misunderstandings but also hinders individuals with bipolar disorder from openly discussing their experiences and seeking support.

Reducing stigma and promoting understanding are crucial steps towards creating a compassionate society that supports individuals with bipolar disorder. Educating the public about the true nature of bipolar disorder, highlighting the strengths and resilience of individuals living with the condition, and providing resources for support and education can help combat these misconceptions.

By acknowledging the impact of bipolar disorder on personal relationships, understanding the challenges faced by individuals with the condition, and challenging societal stigma, we can foster an environment that promotes empathy, acceptance, and support for those affected by bipolar disorder.

Treatment and Management of Bipolar Disorder

Effective management of bipolar disorder is essential for individuals to lead stable and fulfilling lives. Treatment typically involves a combination of medication, therapeutic approaches, and lifestyle changes. In this section, we will explore the different options available for treating bipolar disorder.

Medication Options for Bipolar Disorder

Medication plays a crucial role in managing bipolar disorder and stabilizing mood swings. Mood-stabilizing medications are commonly prescribed, such as lithium, which has proven efficacy in reducing the frequency and severity of manic and depressive episodes. Other mood stabilizers, such as valproate or lamotrigine, may also be prescribed.

Antipsychotic medications can be used to manage acute manic or depressive symptoms. They help regulate neurotransmitters in the brain, reducing the intensity of mood episodes. Antidepressant medications may be prescribed cautiously in combination with mood stabilizers to address depressive symptoms, considering the risk of triggering manic episodes.

It is important for individuals to work closely with healthcare professionals to find the most suitable medication regimen, as each individual’s response to medication varies. Regular monitoring and adjustments may be necessary to achieve optimal symptom management.

Therapeutic Approaches for Bipolar Disorder

Therapeutic interventions, such as psychotherapy, play an integral role in the treatment of bipolar disorder. Cognitive-behavioral therapy (CBT) can help individuals identify and modify negative thought patterns and behaviors associated with the disorder. Interpersonal and social rhythm therapy (IPSRT) focuses on stabilizing daily routines and addressing interpersonal issues that may trigger mood episodes.

Family-focused therapy involves educating and involving family members in the treatment process, enhancing communication, and providing support to both the individual with bipolar disorder and their loved ones. For those experiencing difficulties with medication adherence, psychoeducation can be beneficial in promoting understanding about the disorder and the importance of treatment.

Lifestyle Changes to Support Mental Health

In addition to medication and therapy, adopting certain lifestyle changes can be beneficial in managing bipolar disorder. Regular exercise has been shown to improve overall mood, reduce stress, and promote better sleep patterns. A balanced and nutritious diet can also contribute to physical and mental well-being.

Establishing a consistent sleep schedule is crucial, as disrupted sleep patterns can trigger mood episodes. Practicing good sleep hygiene, such as creating a calming bedtime routine and maintaining a comfortable sleep environment, is recommended.

Avoiding or minimizing the use of alcohol and recreational drugs is important, as these substances can negatively interact with medication and exacerbate mood symptoms. Building a strong support system, including seeking support from support groups or engaging in individual counseling, can provide valuable emotional support.

While bipolar disorder presents unique challenges, it is a treatable condition. By finding the right combination of medication, therapeutic approaches, and lifestyle changes, individuals with bipolar disorder can stabilize their moods, reduce the severity and frequency of episodes, and lead fulfilling lives. A comprehensive treatment approach that addresses the complex biological, psychological, and social aspects of the disorder is key to managing and mitigating the impact of bipolar disorder on daily functioning. Collaborating with healthcare professionals and accessing necessary support systems are vital steps towards successful management of this condition.

Writing an Essay on Bipolar Disorder

Writing an essay on bipolar disorder allows for a deeper exploration of this complex topic. However, it is important to approach the subject with sensitivity, accuracy, and a focus on providing valuable information. In this section, we will discuss key considerations when writing an essay on bipolar disorder.

Choosing a Focus for the Essay

Bipolar disorder encompasses a wide range of topics, so it is essential to narrow down your focus based on your interests and the scope of your essay. Consider exploring specific aspects of bipolar disorder, such as its impact on creativity, the relationship between bipolar disorder and substance abuse, or the experiences of individuals living with bipolar disorder.

Structuring the Essay

Organizing your essay in a logical manner is crucial for conveying information effectively. Consider using the introduction to provide an overview of bipolar disorder and set the context for the essay. Each subsequent section can delve deeper into specific aspects, such as symptoms, diagnosis, impact on relationships, treatment options, and societal understanding. Conclude your essay by summarizing key points and highlighting the significance of promoting awareness and support for individuals with bipolar disorder.

Addressing Controversial Topics

Bipolar disorder is a complex and multifaceted subject that may touch upon controversial areas. When discussing topics such as medication use, alternative therapies, or the link between creativity and bipolar disorder, it is important to present balanced viewpoints supported by credible sources. Acknowledge differing perspectives and engage in evidence-based discussions while considering potential biases or limitations in existing research.

Providing Reliable Sources

To ensure the credibility and accuracy of your essay, consult reputable sources that provide evidence-based information on bipolar disorder. Peer-reviewed academic journals, government health websites, and renowned mental health organizations are reliable sources of information. Remember to properly cite your sources using a recognized citation style, such as APA or MLA, to give credit to the original authors and avoid plagiarism.

Writing an essay on bipolar disorder provides an opportunity to educate and inform readers about this complex condition. By selecting a focused topic, structuring your essay logically, addressing controversies with balanced viewpoints, and using reliable sources, you can create an informative and compelling piece that contributes to understanding and promoting empathy for those with bipolar disorder. It is imperative to approach the topic with sensitivity and respect, recognizing the impact it has on individuals, their relationships, and society as a whole.In conclusion, bipolar disorder is a complex and multifaceted mental health condition that significantly impacts individuals and society as a whole. This in-depth essay has provided a comprehensive understanding of bipolar disorder, covering various aspects such as its definition, prevalence, and impact on personal relationships. We explored the different types of bipolar disorder and the causes and risk factors associated with its development.

Furthermore, we delved into the symptoms and diagnostic criteria used for identifying bipolar disorder while highlighting the importance of distinguishing it from other mental health conditions. The essay also shed light on the challenges faced by individuals with bipolar disorder, including the strain on personal relationships and the societal stigma surrounding the condition.

The treatment and management of bipolar disorder were extensively discussed, emphasizing the significance of medication options, therapeutic approaches, and lifestyle changes to support mental health. By adopting a comprehensive treatment approach, individuals with bipolar disorder can stabilize their moods and lead fulfilling lives.

Moreover, this essay provided insights into writing an essay on bipolar disorder, guiding readers on choosing a focus, structuring the essay effectively, addressing controversial topics, and providing reliable sources. By following these principles, writers can effectively promote awareness and understanding of bipolar disorder.

It is crucial to recognize the impact of bipolar disorder and combat societal misunderstandings and stigmas. By fostering empathy, educating the public, and providing support systems, we can create an inclusive and compassionate society that supports and empowers individuals living with bipolar disorder.

In conclusion, understanding bipolar disorder is integral to promoting mental health and fostering a more informed and accepting society. By spreading knowledge, reducing stigma, and advocating for appropriate support and resources, we can work towards creating a world where individuals with bipolar disorder can lead fulfilling and meaningful lives.

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Essay on Mental Disorder

Introduction

Biologically, there are several psychological conditions causing abnormality and poor performance of the body depending on the part affected by such disease. According to the research, a disorder is an adverse condition characterized mainly by abnormal feelings, behaviors, and thoughts. These characteristics can be either primary or secondary, depending on how the person was affected by them. Primary disorders are mostly genetic conditions acquired from the parents and can be inherited from one generation to another. According to Auerbach  et al.; 2019 secondary abnormalities can be caused by environmental factors and how individuals interact with others. For example, deep stress and depression are secondary disorders caused by the environment and people you interact with daily. In other words, the disorder is a psychopathology that is characterized mainly by abnormal features, thus promoting negative affections. Currently, the mental disorder is the most abnormal conditions affecting both youth and adults. This article’s main idea is to have definitive discussion on how psychological disorder affects human brain’s functionality. Additionally, the research will focus on how disorder can be identified and diagnosed before it reaches its critical point.

Mental disorder

The most straightforward approach to identifier disorder is having regular medical checkups and daily clinics. This enables us to understand our body conditions early, such that if there is any disorder, we can seek medication early enough for diagnose. In most cases, the conceptualization of psychological disorders is understanding personal behaviors, feelings and thoughts. According to the medical experts, the physiological disorder is an emotional condition; thus, nobody can use identifiers abnormally. For example, stress and depression can only be felt by an individual and nobody else. Therefore, according to the Medical institution Association (MIS) publications, identification and diagnosis of disorder depend on personal awareness. This article argues that mental disorder has become the most effective internationally compared to others. As per data analysis, a mental disorder in the United States of America affects more than 48%, both younger and adult (Carleton, Afifi, Turner, Taillieu, Duranleau, Boutillier & Asmundson, 2018). This mental abnormality’s leading cause is depression and stress, resulting from deep thoughts, with no conclusion. A mental disorder is a form of the disease that affects body cognition, behavior, and general emotions. Mental disorder is believed to have prolonged interferences in both youths and adults since it affects performing work. Additionally, the effect slows down the understanding rate and affects most students’ expected performances if not identified in the early stages.

One characteristic of mental trauma is deep stress and persistent depressions, especially when an individual is not comfortable with something. Research shows that mental disturbance begins in early life and may run chronically in an individual’s life if not identified. Basing this research, there are several questions that we need to understand, especially regarding disorders. Firstly, there is a need to know how we can diagnose specific conditions after been identified. In mental disorders, the best diagnosis is having frequent guidance and engaging in sports and game activities (Gill et al.; 2017). Engaging in the games limits the frequency of depression and stress, thus limiting mental disorders. Consequently, seeking frequent guidance and concealing from mental experts promotes mental health, especially to the people who feel are desperate and rejected by their society.

According to the mental experts, this is the only best way of dealing with a mental disorder. The other way of mental diagnosis is to seek medical care, which provides the affected patients with appropriate treatment to lower depression and stress (Monahan et al.; 2016). According to the arguments of professor Weiss 2018, the mental disorder is a form of stigma which affects people due to rejections from their families. It is believed that this form of stigma is facilitated mainly by lack of parental care to most youth people. Not only to the youths, but stigmatization also affects any individual regardless the age or class. The psychiatrists provide a medical diagnosis to the individual having mental disorders by assessing the signs, symptoms, and impairment conditions related to the mental traumas.

In response to other medical professors, such as mental health psychologists may either apply the same strategy depending on their state or condition. Most people suffering from mental disorders are assessed to get clinical information of the client, thus allowing the doctors and nurses to think about which mechanism to apply in diagnosing the condition (Telles et al.; 2018). In the identification of mental disorders, routine diagnostic practices are used by medical experts mostly to know the type of the disorder and how to approach it. With this, evaluations are made basing the appearances and the expected behavior of the individuals. To diagnose the identified condition, such as mental illness, both interview and physical examinations are needed to first

According to this article’s arguments, psychological testing can be suitably used via pen and paper or electronic forms, thus including algorithms based on indicating diagnostic criteria to the affected individuals. This article shows that time and budget of diagnosis constraints, limiting psychiatrists from conducting ethical diagnostic evaluations. It has been found that most clinics related to mental health evaluate patients primarily using an unstructured approach. As per the medical guidelines, any medical expert must have enough training before conducting any psychological assessment on the people who reacted with mental disorders.

Paula Caplan is one of the experts who have been concerned with psychiatric diagnosis basically for the people facing mental disorders. From his arguments, people who a psychiatric disorder has arbitrarily slapped have higher fusibility to other psychological conditions such as traumas; thus, they need care and medication (Telles et al.; 2018). Psychological abnormality is a definitive disorder that requires a lot of care and frequent medication, especially to patients in a critical state. Therefore, according to this research, it’s the doctor’s responsibility to ensure patients living with mental issues have been cared for. Basing the arguments of  “The New Crisis of Confidence in Psychiatric Diagnosis,”  psychological diagnosis mainly depends on fallible subjective assessment rather than biological and interview tests.

In conclusion, to prevent mental disorders, there must be effective ways to reduce the rate at which these psychological abnormalities spreads. The European Psychiatric Association (EPA) gives further guidance on how mental illness and disorders can be approached. Apart from direction and counseling to the people slapped by stress and depression, intervention preventions can be considered the best method to approach mental illness and disorder. As pointed earlier, this article’s main focuses are to have a definitive discussion on the conditions, especially mental illness, since it’s the most significant threat internationally. According to my recommendations, it’s good for every individual to have a regular medical clinic, primarily related to mental health.

Auerbach, R. P., Mortier, P., Bluffer’s, R., Alonso, J., Bennet, C., Chippers, P., … & WHO WMH‐ICS Collaborators. (2019). Mental disorder comorbidity and suicidal thoughts and behaviors in the world health organization world mental health surveys international college student initiative.  International journal of methods in psychiatric research ,  28 (2), e1752.

Carleton, R. N., Afifi, T. O., Turner, S., Taillieu, T., Duranleau, S., LeBoutillier, D. M., … & Asmundson, G. J. (2018). Mental disorder symptoms among public safety personnel in Canada.  The Canadian Journal of Psychiatry ,  63 (1), 54-64.

Gill, P., & Corner, E. (2017). There and back again: The study of mental disorder and terrorist involvement.  American Psychologist ,  72 (3), 231.

Monahan, J. (2016). Mental disorder and violent behavior: perceptions and evidence.  American Psychologist ,  47 (4), 511.

Telles-Correia, D., Saraiva, S., & Gonçalves, J. (2018). Mental disorder—the need for an accurate definition.  Frontiers in psychiatry ,  9 , 64.

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Introduction

• Published: February 2008
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The effects of mental disorder are apparent and pervasive, in suffering, loss of freedom and life opportunities, negative impacts on use of education, work satisfaction and productivity, complications in law, institutions of healthcare, intensive scientific research into causes and cures and so on. Suffering, loss of functioning, and perceived threat are among the personal and social experiences that can lead to mental health services. Once the problems are brought to the attention of mental health services and mental disorder is diagnosed, a range of possible outcomes is licensed, including offer of treatment, funding and perhaps, depending on severity and other circumstances, paid leave from work due to illness, possible shame and stigma, and in extreme cases compulsory admission to hospital, or acceptance of no or diminished responsibility in the Courts. Mental health professionals engage with the problems inside institutional structures using manuals for diagnosis and providing treatments that are increasingly required to be backed by scientific evidence of effectiveness. The social and institutional outcomes of assigning a diagnosis are important topics for social scientific theory and research. However, earlier in the chain of events and consequences are the social manifestations of mental disorder, open for all to see, and most importantly the personal and interpersonal effects, experienced by the people with the problems, their families and friends.

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Psychology Discussion

Essay on mental disorder | psychology.

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Here is a compilation of essays on ‘Mental Disorder’ for class 9, 10, 11 and 12. Find paragraphs, long and short essays on ‘Mental Disorder’ especially written for school and college students.

Essay on Mental Disorder  

Essay Contents:

• Essay on the Prevention of Mental Disorders

Essay # 1. Introduction to Mental Disorder:

Some people over react to simple statements and situations. Some have difficulty in relating to other people, some often find fault with their colleagues and family members and feel threatened; others seem to experience hallucinations and delusions. Often we dismiss these people sometimes casually and sometimes with fear, as “mad” or “eccentric.” Morbidity on account of mental illness is set to overtake cardiovascular diseases as the single largest risk in India.

According to NIMHANS, there are over two crore people in India who are in need of treatment for serious mental disorders and about five crore people who are affected by common mental dis­order. About 30 to 35 lakh people need hospitalization at any time for mental illness. As Mohandas (2009) has observed the situation is alarming.

He noted that “a meta-analysis of 13 epidemiological studies consisting of 33,572 persons reported a total morbidity of 58.2 per 1000. Another meta-analysis of 15 epidemiological stud­ies reported a total morbidity of 73 per 1000. The saddest aspect is that the bulk of the affected falls in the 15 to 45 year age group. The existing facilities in the country fall short of the required norms, which makes the situa­tion still worse. The number of psychiatric beds in the country is only about 0.2 per 1, 00,000 population and there are only two psychiatrists per 10 lakh population”.

Math and Srinivasraju (2010) have estimated that about 20 percent of the adult population in the community is affected with one or the other psychiatric disorder. In particular female gender, children and adolescents, students, aged people, people suffering from chronic medical condition, disabled, disaster survivors, people in custodial care, marginalized persons, refuges and individuals with poor family, social and economic support are found at high risk of develop psychiatric disorders.

To a psychologist, the problems related to mental disorders are as fascinating as they are disturbing.

But what, precisely, are mental disorders? This question is much harder to answer than you might at first assume, because in fact there is no hard-and-fast dividing line between behavior that is normal and behavior that is somehow abnormal; rather, these are simply end points on an unbroken dimension.

That said, most psychologists do agree that mental disorders include the following features. First, they involve patterns of behavior or thought that are judged to be unusual or atypical in the society. People with these disorders don’t behave or think like most others, and these differences are often apparent to the people around them. Second, such disorders usually generate distress negative feelings and reactions in the persons who experience them. Third, mental disorders are maladaptive they interfere with individuals’ ability to function normally and meet the demands of daily life.

Combining these points, we can define mental disorders as disturbances of an individual’s behavioral or psychologi­cal functioning that are not culturally accepted and that lead to psychological distress, behavioral disability, and for impaired overall functioning.

Essay # 2. Models of Abnormality- Changing Conceptions of Mental Disorders:

The pendulum of history swings, and like other pendulums, it does not move in only one direction. Over the course of the centuries and in different societies, mental disorders have been attributed to natural factors or forces for example, to imbalances within our bodies or, alternatively, to supernatural ones, such as posses­sion by demons or gods. Let’s take a look at a few of these historical shifts, then turn to the modern view of mental disorders: models of abnormality that provide comprehensive accounts of how and why mental disor­ders develop and how they can best be treated.

From the Ancient World to the Age of Enlightenment:

The earliest views of abnormal behavior emphasized supernatural forces. In societies from China to ancient Babylon, unusual behavior was attributed to possession by evil spirits or other forces outside our everyday experience. Ancient Greece, however, provided an exception to this picture.

Several centuries before the start of the Common Era, Hippocrates, a famous Greek physician, suggested that all forms of disease, including mental illness, had natural causes.

He attributed psychological disorders to physical factors such as brain damage, heredity, and the imbalance of humors within the body four essential fluids that, he believed, influenced our health and shaped our behavior. He even suggested treatments for these disorders that sound impressively modern: rest, solitude, and good food and drink.

The Romans generally accepted this view of psychological disorders, and because the Romans spread their beliefs all around what was then the known world, the idea of psychological disorders as the result of natural rather than supernatural causes enjoyed widespread accep­tance, too. These views, of course, provided the foundations for what is known as the medical view of mental disorders the idea that such disturbances stem from natural biological causes and should be treated as forms of illness.

In the Indian context earliest reference to psychological disorders is found in the Atharava Veda, which is dated around second millennium BCE. It describes three metabolic processes or tridoshas as vata, pitta, and kaph and three gunas as sattva, rajas, and tamas. It is believed that a predominance of Tamas guna is manifested in mental disorders. Some of these are Unmad, Grahi (fit or seizure), Apasmar, Bhaya (fear), Manastap (anxiety), etc.

With the start of the Renaissance in the 1400s, however, the pendulum swung once again. The Swiss physi­cian Paracelsus (1493-1541) suggested that abnormal behavior might stem, at least in part, from the influence of natural forces such as the moon, which, he believed, influenced the brain and induced madness or lunacy.

A few decades later, the physician John Weyer (1515-1588) emphasized the role of natural, physical causes in mental disorders and was, in a sense, the first psychiatrist (medical doctor specializing in the treatment of mental disorders). As the Renaissance continued, and as knowledge of anatomy and biology increased, Weyer’s view that abnormal behavior was a kind of illness gained acceptance. He also objected to the brutal way in which people with mental disorders were treated.

Change, however, was in the wind. During the 1700s reformers called attention to these problems, and in 1793 Philippe Pinel (1745-1826), a French physician in charge of a large mental hospital in Paris, unchained the patients, arguing that they would do much better if treated in a kinder fashion. These changes did pro­duce beneficial effects, so Pinel’s ideas soon spread and did much to reduce the suffering of patients in such “hospitals.”

The result, ultimately, was the development of the moral treatment or mental hygiene movement, and during the nineteenth century reformers secured improved conditions for many persons experiencing mental disorders. However, the movement soon produced results its supporters did not foresee: It led to estab­lishment of new state hospitals (mainly in the early decades of the twentieth century) that were so understaffed that they could offer only custodial care to the large number of patients they housed. However, these facilities did allow psychiatrists to study and compare the symptoms of many patients; this work led, ultimately, to the development of improved ways for describing and classifying mental disorders.

Modern Perspectives: Biological, Psychological, Sociocultural, and Diathesis-Stress Models:

So how are mental disorders viewed today? The answer involves several perspectives that should be viewed as complementary to one another. Together, these approaches provide a more accurate and complete picture of how such disorders arise and how they can be treated than any single perspective does alone.

One of these approaches, the biological model, emphasizes the role of the nervous system in mental disorders. This approach seeks to understand such disorders in terms of malfunctioning of portions of the brain, imbalances in various neurotransmitters and genetic factors.

For example, many mental disorders show a high degree of concordance among close relatives. If one family member develops a disorder, then others are at increased risk for developing it too.

It is clear, however, that biological factors are not the entire story where mental disorders are concerned. Often, such disorders occur without any apparent underlying biological cause. This suggests that psychological factors, too, can be important. The psychological perspective emphasizes the role of basic psychological processes in the occurrence of mental disorders.

For instance, many psychologists believe that learning plays a key role in many disorders. An example- phobias, or excessive fears of objects or situations. According to the psychological view, a boy who is humiliated in front of classmates by an insensitive teacher may acquire a fear of all social situa­tions in which he is the center of attention, and may avoid them on future occasions. The psychological perspective also emphasizes the role of cognitive factors in mental disorders.

For example, individuals may attribute positive events and accomplishments to luck and other factors beyond their control, but negative outcomes to internal factors such as their own flaws or failings. Finally, the psychological perspective also takes account of unconscious forces and conflicts within individuals—the factors so vividly emphasized by Freud and his followers.

What about sociocultural factors do they too play a role in mental disorders? Psychologists and other mental health professionals believe that they do, and point to the important role of such social variables as poverty, unemployment, inferior education, and prejudice as potential causes of at least some mental disorders. In other words, the sociocultural perspective emphasizes the fact that external factors such as negative environ­ments, a disadvantaged position in society, and cultural traditions can play a role in mental disorders.

A third modern perspective on mental disorders is the diathesis-stress model.

This view suggests that men­tal disorders result from the joint effects of two influences:

(1) A predisposition for a given disorder, termed a diathesis, and

(2) Stressors in an individual’s environment that tend to activate or stimulate the predisposition or vulnerability.

In other words, the diathesis-stress model suggests that for various reasons—genetic factors, early traumatic experiences, specific personality traits; individuals show varying degrees of vulnerability to specific mental disorders. Whether and to what extent an individual actually experiences such a disorder, however, de­pends on the environment in which the person lives.

If the environment is favorable, the vulnerability (diathesis) may never be activated, and the person may never experience a mental disorder. If environmental factors are unfavorable, the diathesis may be activated, and one or more mental disorders may result.

The diathesis-stress model has also played an important role in the emergence of a new perspective in the study of mental disorders, one that emphasizes the development of such disorders over time. This approach, often known as the developmental psychopathology perspective, emphasizes the fact that problems that first appear during childhood or adolescence often are linked to and serve as precursors for disorders that occur later in life.

In India, issues pertaining to mental health could not received due attention until recently. There is, however, increasing realization that con­ditions such as schizophrenia, mood disorders (bipolar, manic, depressive, and persistent mood disorders), and mental retardation can impose a marked disease burden on Indians. This was confirmed by a study conducted for the NCMH which stated that at least 6.5 percent of the Indian population had some form of serious mental disorder, with no discernible rural-urban differences; women had slightly higher rates of mental disorder than men.

If one were to include some other “common” mental disorders and alcohol and drug dependency, the estimates would be substantially higher. With the increasing size of the population, these numbers are expected to grow substantially by 2015; the population with serious disorders is expected to grow to more than eight crore in that year, and even higher if the category of “common mental disorders” in the population was included in the projections.

Reddy and Chandrashekar (1998) in a meta-analysis reported the total prevalence to be 58/1000 (confidence interval [CI] 55.7-60.7) with 48.9/1000 for the rural population, and 80.6/1000 for the urban population. Ganguli (2000), reviewing major Indian studies, computed the total rate to be 73/1000 (range: 18-207).

These studies utilized different inclusion and exclusion criteria and hence the number and type of studies included are not the same. The awareness and response of the people to mental health needs to be quite varied. The experiences of clinical psychologists as given in the Box indicate that much is still required to increase the awareness of the people.

Essay # 3. Mental Health Challenges in the Indian Society- The Changing Scenario:

In 1960s no one ever realized that a psychologist was an essential part of life. Only if a child was grossly retarded, an IQ evaluation was required. People resented the concept of family counseling. I remember an elderly man saying about me: “Will this lady tell me how I must run my family? What nonsense”. Today, a large number of parents consult for their children’s aggressive nature, for their poor academic involvements besides issue like ADHD, autism, etc.

A large section of more boys but girls also come for counseling because of an Oppositional disorder. A XII th class girl aged 17 and her brother aged 20 wanted to cook noodles and realized that the stock at home had finished. They sneaked the keys of the main door from under the pillow of their grandmother and left house at 2 a.m. to buy noodles. Some boys passing by caught the girl and raped her while the brother looked with hands and mouth tied.

When the boys left, the sister untied the brother. Out of anger, the brother beat up an elderly woman in rags passing by who had no con­nection with this episode. They came back home. The parents were up hearing some noise because when the children entered the house they slammed the door. The parents and the children shouted at each other in a heated argument and eventually the girl beat her mother and the brother beat up his father. Both the brother and sister have a very poor academic record.

These are very common cases coming up these days. Pubs leading to better drinking facilities add to the youth’s problems. So the family environments are deteriorating. The materialistic thrust within the parents reduces the Indian values within the Indian socio-cultural context. Thus the intergenerational conflicts are reportedly more in clinics. The urban problem worth reporting is of grave concern.

This is the problem of E Addiction. The adolescent and the early youth is addicted to the television, the laptop, the IPod and now the Ipad. There can be violence between the parent and the ward over these gadgets because the ward is unable to sleep or study. The face book is the main occupation of the youngsters. Try getting them away, there can be lethal war in the family which has also led to rede­fining the new Indian concept influenced by the West “It is my life and this is my space. You have nothing to do with it.”

So many issues arise like a disturbed sleep cycle, poor hygiene, poor academic health, poor social health and poor physical health due to lack of movement and exercise, junk food, etc. It also leads to poor concentration and poor attention processes. It leads to poor memory es­pecially recall of a bulk material in the current ex­amination system we have in schools.

Another set of cases that frequently visit the psychologist are the marriage counseling issues. Women with a logically developed educated mind find it difficult to withstand the illogically dominat­ing nature of their husband get defiant and become extramarital.

Face back and online chats and the internet sex gives them enough opportunity to get romantically and sexually happy without the excess baggage of either the patriarch or the joint family hasseles. Very many times this is the outcome of a very throttling and a controlling husband who may be paranoid or obsessive in nature or it may be that the woman is a borderline bipolar depressive with also an overlay of obsessional disorder.

The awareness of psychological issues and the emerging role of the psychologist however still leave scope for the astrologer and the tantric. So the old and the new run together.

A very regular client of mine who had marital issues because the girl would not allow any sexual relations as she did not like her husband but was forced into marriage by her father (was suffering from childhood depression) always consulted her family Panditji. She would confide in her sessions that her Panditji said that if she had sexual relations with her husband, he would die of epilepsy. (The husband was epileptic).

This suited her so she would listen to his advice. If he really had given it, one does not know. So she would wear all kinds of stones in her rings on her fingers. The blend of such beliefs and newer psychological methods is more prevalent in the urban areas. There is still more work for the psychologists to show their relevance so that the stigma for counsel­ing would go.

Essay # 4. Assessment and Diagnosis of Mental Disorders:

In order to assess and diagnose mental disorders, psychologists go through a set of steps when seeing a new patient for the first time. The psycholo­gist would first gather information on the kind of problems the person is experiencing, inquire about conditions in her or his current life, examine the person’s responses to various psychological tests, and so on.

These information-gathering steps are known as assessment, and they are directed toward the goal of formulating an accurate diagnosis identification of the person’s problem(s).

Diagnosis is a crucial step, because identifying the problem often determines what the psychologist should do next how she or he can best help the individual. But how does the psychologist identify the specific disorder or disorders a given person is experiencing? To this end psy­chologists and other mental health professionals have an agreed-upon system for describing and classifying mental disorders.

Actually, several different systems for classifying mental disorders. However, the one that is the most widely used in the United States is the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), published by the American Psychiatric Association (1994).

Although this manual is published by the American Psychiatric Association, psychologists have long contributed to its develop­ment and increasingly so in recent years. Thus, the manual is designed to help all mental health practitioners correctly identify (diagnose) specific disorders. The DSM-IV (TR) has also been published in 2000 which includes certain modifications.

The manual describes hundreds of specific disorders many more than we’ll consider here. These descriptions focus on observable features and include diagnostic fea­tures symptoms that must be present before an individual is diagnosed as suffering from a particular problem.

In addition, the manual also provides much additional background information on each disorder; for instance, information about biological factors associated with the condition and about variations in each disorder that may be related to age, cultural background, or gender.

The DSM-IV classifies disorders along five axes rather than merely assigning them to a given category. This means that a person is described along several different dimensions (axes) rather than only one. Different axes relate to mental disorders, physical health, and social and occupational functioning.

For our purposes, two of these axes are most important- Axis I, which relates to major disorders themselves, and Axis II, which relates to mental retardation and to personality disorders—extreme and inflexible personality traits that are distressing to the person or that cause problems in school, work, or interpersonal relationships.

The third axis pertains to general medical conditions relevant to each disorder; the fourth axis considers psychosocial and environmental factors, including specific sources of stress. Finally, the fifth axis relates to a global assessment of current functioning. By providing a system for evaluating people along each of these various axes, the DSM-IV helps clinicians gain a fuller picture of each patient’s current state and psychological functioning.

Is the DSM-IV a useful tool for psychologists? In several ways, it is. It appears to be higher in reliability than earlier versions, and it rests more firmly on careful empirical research. However, it’s important to note that it is still largely descriptive in nature. It describes psychological disorders, but it makes no attempt to explain them. This is deliberate; the DSM-IV was specifically designed to assist in diagnosis.

It remains neutral with respect to various theories about the origins of psychological disorders. Because psychology as a science seeks explanation, not simply description, however, many psychologists view this aspect of the DSM-IV as a short­coming that limits its value.

In addition, the DSM-IV attaches specific labels to people, and this may activate stereotypes about them. Once a person is labeled as showing a particular mental disorder, psychologists and mental health professionals may perceive the person largely in terms of that label; and this may lead them to overlook important information about the person.

A third criticism is that the DSM-IV may be gender-biased. Females are diagnosed as showing certain disorders much more frequently than males, and some critics suggest that this is due to the fact that the DSM—IV descriptions of these disorders seem to reflect society’s views about women (sex-role stereotypes).

Finally, the DSM-IV has been criticized because mental disorders occur on a continuum, not in discrete categories. People don’t necessarily simply have or not have a disorder; they may have the disorder to various degrees, and may show different aspects of it in varying proportions. For this reason, many psychologists prefer a dimensional approach, in which individuals are not simply assigned to specific categories but rather are rated on many different dimensions, each relevant to a specific mental disorder.

Still, although many psychologists might prefer a dimensional approach, and although they recognize the other potential problems with the DSM-IV already noted, they continue to use the manual because of the benefits of having a single widely used framework for describing and discussing mental disorders.

Essay # 5. Treatment for Mental Disorders:

Growing evidence suggests that individual psychotherapy works: Many of the kinds of therapy we have already considered are effective in alleviating mental disorders. But there are several factors that limit the usefulness or appropriateness of such procedures in some cases.

First, and perhaps most important, individual psychotherapy is not accessible to all persons who might benefit from it. It is often quite expensive skilled therapists often receive Rs.2000 or Rs. 3000 per hour! Obviously, many people can’t afford such costs.

But even if individual psychotherapy were free, cultural factors limit its accessibility for some groups of people. In many cultures, for example, it is considered unseemly to express one’s emotions openly or to dis­cuss them with other persons—especially with total strangers (which is what therapists are, at least initially).

The result is that people from many non-Western cultures and persons from some ethnic groups (e.g., people of Hispanic or Native American descent in the United States) view individual psychotherapy as pointless or even shameful as a sign of weakness.

This situation is definitely not helped by what has been described as cultural insensitivity in the mental health field, at least in the past. Such insensitivity has resulted not from prejudice or other negative reactions on the part of therapists, but rather from an insistence on using standard procedures and assessment tools that may not be appropriate for various cultural groups.

Other factors limiting the usefulness of individual psychotherapy include its emphasis on individuals, a focus that overlooks the fact that social factors (e.g., conflicts and relationships with others) often play an important role in mental disorders, and its emphasis on treatment rather than on prevention. Preventing mental disorders has become an important theme in psychology, just as preventing physical illness has become an important aspect of modern medicine.

Largely in response to these and other limitations, alternative forms of treatment for mental disorders have been developed.

Several of these are described below:

1. Group Therapies- Working Together to Solve Personal Problems :

Group therapies involve procedures in which several people discuss their problems with one another under the guidance of a trained therapist. In some cases the procedures followed in group therapies are derived from spe­cific forms of individual psychotherapy. For instance, techniques developed by Freud for individual therapy have also been modified for use in psychodrama a form of group therapy in which group member’s act out their prob­lems in front of one another, often on an actual stage.

Psychodrama also involves such techniques as role reversal, in which group members switch parts, and mirroring, in which they portray one another on the stage. In each case the goal is to show clients how they actually behave and to help them understand why they behave that way—what hidden inner conflicts lie behind their overt actions.

In contrast, behavioral group therapies are derived from the basic principles of learning that underlie behav­ior therapies. Such therapy has been found to be especially useful in teaching people basic social skills, such as how to communicate their wishes to others and how to stand up for their rights without being aggressive. It has also proved helpful in teaching people self-control the ability to regulate their own behavior.

Psychologists who practice phenomenological/experiential therapies have perhaps been the most enthusi­astic about adapting their techniques to group therapy. In fact, interest in group therapy first originated among humanistic therapists, who developed two forms of such therapy; encounter groups and sensitivity-training groups.

Both of these techniques focus on the goal of fostering personal growth through clients’ increased un­derstanding of their own behavior and through increased honesty and openness in personal relations. In both kinds of groups, members are encouraged to talk about the problems they encounter in their lives. The reactions they receive from other group members then help them understand their own responses to these problems.

The major difference between encounter groups and sensitivity-training groups lies in the fact that encounter groups carry the goal of open exchange of views to a greater extreme. Members in these groups are encouraged to yell, cry, touch each other, and generally to act in a completely uninhibited manner. Sensitivity-training groups, in contrast, are somewhat more subdued.

In practice, most group therapy involves six to twelve persons, plus a therapist. Sessions last about two hours—twice as long as most sessions of in­dividual psychotherapy. Yet costs can be relatively low, because group members, in essence, share the therapist’s fee. Do such groups really produce bene­ficial changes?

Growing evidence suggests that they can indeed be helpful, primarily because they pro­vide the following benefits:

(1) People participating in these groups learn that their problems are not unique but that in fact they are shared by many other persons.

(2) Group ther­apy sessions encourage hope—when group mem­bers see others coping with their problems, they realize that they too can do the same.

(3) Persons in group therapy sessions share information with one another—suggestions on how to cope with specific problems and insights into these problems.

(4) Group therapy sessions give members a chance to practice altruism—to offer help to others; and this can boost their self-esteem.

(5) Group therapy sessions offer a supportive environment in which to practice basic social skills. When these potential benefits are combined, it is not surprising that group therapies can sometimes be very beneficial for the persons who participate in them.

Marital and Family Therapies: Therapies Focused on Interpersonal Relations:

Although group therapies take place in settings where several people are present, these therapeutic approaches often search for the roots of mental disorders in processes operating largely within individuals for instance, in inner conflicts, faulty habits, distorted self-concepts, faulty learning.

In contrast, two other kinds of therapy marital therapy and family therapy focus on the potential role of interpersonal relations in mental disorders and psychological problems. In other words, therapies in this category assume that individuals experience personal problems because their relations with important persons in their lives are ineffective, unsatisfying, or worse. Let’s now examine two important forms of therapy that adopt this interpersonal perspective.

2. Marital Therapy- Spouses as the Intimate Enemy :

In the United States and many other countries, more than 50 percent of all marriages now end in divorce. Moreover, the marriage rate has dropped sharply in recent years; it seems that young people may see these odds in increasingly unfavorable terms. Of course, keeping people in joyless marriages or mutually destructive relationships is defi­nitely not a goal of therapy.

Rather, marital therapy (sometimes termed couples therapy) is designed to help couples who feel that their marriage is worth saving. In addition, marital problems are related to several mental disorders, including depression, anxiety, and drug dependency so marital therapy can be beneficial in helping people avoid these problems.

Before turning to the procedures used in such therapy, however, let’s first consider a very basic question- What, in your opinion, is the number one reason why couples seek professional help in the first place? If you guessed “sexual problems,” guess again; such difficulties are a distant second on the list. Problems relating to communication are far and away the number one cause of dif­ficulties.

People entering marital therapy often state that their partner “never talks to them” or “never tells them what she/he is thinking.” Or they report that all their partner ever does is complain. “He/she never tells me that he/she loves me,” they remark. “All he/she does is tell me about my faults and what I’m doing wrong.” Given that couples begin their relationships with frequent statements of mutual esteem and love, the pain of such faulty communication patterns is doubled. Each person wonders what went wrong and then generally blames his or her partner!

Now, back to the specific goals and procedures of marital therapy. One type, behavioral marital therapy, focuses on the communication problems I have just emphasized. Therapists work to foster improved com­munication in many ways, including having each partner play the role of the other person so as to see their relationship as the other does. Other techniques involve having couples watch videotapes of their own interac­tions.

This procedure is often a real eye-opener- “Wow, I never realized that’s how I come across!” is a common reaction. As communication between members of a couple improves, many other beneficial changes occur; for instance, the partners stop criticizing each other in destructive ways, express positive sentiments toward each other more frequently, and stop assuming that everything the other person does that annoys or angers them is done on purpose.

Once good communication is established, couples may also find it easier to resolve other sources of fric­tion in their relationships. The result may then be a happier and more stable relationship a relationship that increases, rather than reduces, the psycho­logical well-being of both partners.

Other forms of marital therapy focus not on specific skills that can help people get along better but on gaining insight into the causes of couples’ problems. Such insight marital therapy and behavioral marital therapy have both been found to be helpful. Couples who undergo such therapy are more likely to stay together and report being happier than couples who do not.

3. Family Therapy- Changing Environments That Harm:

Let’s begin with a disturbing fact: when individuals who have been hospi­talized for the treatment of serious mental disorders and who have shown improvements return home, they often experience a relapse. All the gains they have made through individual therapy vanish.

This fact points to an unsettling possibility: Perhaps the problems experienced by such persons stem, at least in part, from their families from disturbed patterns of interaction among family members. To the extent that this is true, attempting to help one member of a family is not sufficient; unless changes are made in the family environment, too, any benefits they have experienced may disappear once they return home.

Recognition of this important fact spurred the development of several types of family therapy; therapy designed to change the relationships among family members in constructive ways.

Such therapies differ in form, but most are based on the following concepts suggested by systems theory, an approach that views families as social systems:

(1) Circular causality—events within a family are interrelated and cause one another in recipro­cal fashion;

(2) Ecology—families are integrated systems, so change in one member will affect all other members; and

(3) Subjectivity—each family member has her or his personal view of family events.

Together, these ideas emphasize the importance of working with all family members. Family members are in constant contact with one another and create an environment in which all exist.

What specific techniques does family therapy involve? Family systems therapy an approach closely linked to the concepts mentioned above assumes that relations among family members are more important in producing mental disorders than aspects of personality or other factors operating largely within individu­als. This approach also assumes that all members of the family influence one another through the complex network of their relationships.

How does family systems therapy work? Here’s an example. Consider a highly aggressive boy who is getting into lots of trouble in school and elsewhere. A family systems approach would assume that this youngster’s difficulties stem, at least in part, from disturbed relation­ships between him and other family members.

Close observation of interactions among the family members might reveal that the parents are locked in bitter conflict, with each trying to recruit the boy to their side. The result, he experiences tremendous stress and anger and directs this outward toward schoolmates and others. Understanding the dynamics of this family, in short, can provide insights into the causes of the boy’s problem. Changing these dynamics, in turn, could help to reduce his difficulties.

In contrast, behavioral approaches (sometimes known as problem-solving therapy) emphasize teaching family members improved, non-coercive ways of communicating their needs and ways of acting that prevent or reduce conflicts.

Does family therapy work? Research findings indicate that in many cases it is quite successful. After un­dergoing such therapy, family members are rated by therapists, teachers, and other observers as showing more adaptive behavior and better relations with one another than was true before the therapy. And family therapy does seem to help reduce problems experienced by individual members. However, as has been the case with many forms of therapy involving several persons, most research on the effectiveness of family therapy has been somewhat informal in nature.

4. Self-Help Groups- When Misery Derives Comfort from Company :

When we are anxious, upset, or otherwise troubled, we often seek comfort and support from others. Long before there were psychologists and psychi­atrists, people sought informal help with personal difficulties from family members, friends, or clergy. This tendency to seek help from people we know, even if they are not professionals, has taken a new form in self-help groups.

These are groups of persons who are expe­riencing the same kinds of problems and who meet regularly, without profes­sionally trained leaders, to help one another in their efforts to cope with these difficulties. Self-help groups are a fact of life; indeed, it has been estimated that more than 5 percent of all adults in the United States are or have been involved in such groups. What kinds of problems do these groups address?

Almost everything you can imagine; in fact, several different types of groups, focusing on contrasting kinds of problems, exist. Habit disturbance self-help groups focus on specific behaviors (e.g., Alcoholics Anonymous, Gamblers Anonymous). General-purpose self-help groups address a wide range of dif­ficulties (e.g., the death of a child or spouse, childhood sexual abuse, be­ing a single parent, divorce, stuttering, and breast cancer).

Lifestyle organizations support individuals such as single parents or the elderly who feel that they are being treated unfairly by society (e.g., Parents without Partners, Gray Panthers). Physical handicap organizations offer support to people with heart disease and other medical conditions (e.g., Mended Hearts).

Significant-other organizations provide support and advocacy for relatives of disturbed persons (Gam-Anon for relatives of compulsive gamblers, Al-Anon for relatives of alcoholics). Finally, reflecting the tragic effects of AIDS, a growing number of self-help groups now focus on assisting persons who have been diagnosed with this illness as well as their friends, relatives, and significant others.

Do self-help groups succeed? Few scientific studies have been conducted on this question, partly because the groups themselves often strictly guard their privacy; but there is some indication that they can be beneficial. In any case, these groups do provide members with emotional support and help them make new friends. These outcomes alone may justify their existence.

5. Psychosocial Rehabilitation :

The development of effective drugs for treating serious mental disorders during the 1950s and 1960s resulted in the release of large numbers of persons from public mental hospitals. Many applauded the deinstitutionalization trend, the shifting of patients from public hospitals to the community. But positive reactions to this change were soon muted by the fact that many of these persons failed to receive regular treatment of any kind after their release. The result? Many were unable to deal with the problems of everyday life and drifted into unemployment and homelessness.

As recognition of these sad facts has grown, efforts by psychologists and other mental health professionals to reach such persons and to help them deal with their disorders increased.

Such efforts, known as psychosocial rehabilitation, center on teaching patients with seri­ous mental disorders (schizophrenia, major mood disorders) to cope more effectively with their disorders and, especially, to avoid or lessen the crises that often stem from these disorders and make it virtually impossible for these patients to function in society.

Psychosocial rehabilitation, in short, does not attempt to cure serious mental disorders; rather, it seeks to help persons with such disorders live as close to a normal life in the community as possible. Efforts to assist patients through psychosocial rehabilitation focus on achiev­ing several goals.

First, a key goal is to help such persons understand their dis­orders so that they can cope with them more effectively. For instance, patients may be taught to recognize early warning signs of deterioration and to avoid high-risk situations. Those with schizophrenia can be taught to recognize the hallucinations that often precede psychotic breaks and lead to arrest or hospi­talization. Such steps can help individuals with serious mental disorders avoid serious trouble.

Second, psychosocial rehabilitation focuses on teaching patients the practical skills they need to live in the community how to use public trans­portation, shop for groceries, prepare meals, and interact with other persons.

Third, efforts are made to have a single professional coordinate effort to help the patient efforts with respect to employment, housing, nutrition, transportation, medical care, and finances. Such case management helps to ensure that patients get all the help available to them and do not “slip between the cracks.”

Growing evidence suggests that psychosocial rehabilitation works. It helps keep persons with serious men­tal disorders from having relapses or from experiencing serious problems with the law. However, such programs are most beneficial if they continue on a regular basis.

Essay # 6. Prevention of Mental Disorders:

The 1960s were a time of social turmoil in the United States and many other countries. Traditional ways of doing things were questioned and rejected in many spheres of life, ranging from education to styles of dress. The field of mental health was no exception to the currents of change that swept through U.S. society, and one of the key shifts to emerge was the development of what came to be known as the community mental health movement a new approach that focused on treating people with mental disorders in their local communities rather than in distant, huge, and often impersonal public men­tal hospitals. This movement was fueled, in part, by the passage of legislation that provided funds for the construction of community mental health centers throughout the United States.

While the community mental health movement produced many beneficial effects, it did not achieve all of the challenging goals it established for itself; and in some respects it was not fully in keeping with the sci­entific approach to mental disorders preferred by psychologists.

But the movement did lead, gradually, to the emergence of a new subfield of psychology known as community psychology; an approach that focuses on promoting mental health through positive change in the community. The field of community psychology is identified by several additional principles as well.

First, it adopts an ecological perspective, the view that the causes of mental disorders stem, at least in part, from the social, economic, and physical environments in which people live, factors such as poverty, disintegrating communities, and poor schools, to name just a few.

This perspective contrasted sharply with the traditional view that mental disorders stem entirely—or at least primarily—from factors within individuals. Because ecological factors often play a role, community psycholo­gists argued, effective treatment of mental disorders should involve efforts to change the social systems in which people live, not just the people themselves.

Second, and perhaps most important of all, community psychology emphasizes prevention—interventions designed to prevent mental disorders from developing in the first place. Three distinct types of prevention became the focus of attention- primary prevention, secondary prevention, and tertiary prevention.

The term primary prevention refers to efforts to prevent new psychological problems from occurring. These efforts include programs aimed at both coun­teracting risk factors and strengthening protective factors—factors that pre­vent mental disorders.

Most programs of primary prevention emphasize the following goals- encouraging secure attachments and reducing family violence, secure attachments to parents or other caregivers appear to play a crucial role in children’s healthy development; teaching effec­tive problem-solving skills—skills that help people get along with others and regulate their own behavior; changing environments—making environments more supportive in many different ways; enhancing stress-coping skills—skills that help people deal with the major stressors they encounter in their lives; and promoting empowerment—helping people who, because of old age, poverty, homelessness, minority status, or physical disability, feel that they have little or no control over their own lives.

Programs directed toward such goals must often involve an ecological approach that addresses the social and physical environments in which people live. For example, do we want to reduce the incidence of child abuse and the harmful effects it produces? Then we must, according to the ecological view, do more than sim­ply provide counseling to parents; we must also try to counter the adverse effects of poverty so that parents have the resources to form warm, supportive bonds with their children and so that they experience less stress (e.g., stress generated by their inability to find decent affordable housing).

In contrast, secondary prevention focuses on groups of people who are at risk for developing a disorder and involves efforts to detect psychological problems early, before they have escalated in intensity. Diversion programs aimed at helping juvenile offenders in the criminal justice system, provide an example of secondary prevention.

It is a well-established fact that once young offenders are placed in prisons, they become more likely to continue their dangerous antisocial behaviors; such institutions are often more like training schools for criminal activities than anything else. In diversion programs, young offenders are steered away (diverted) from such institutions and given another chance to learn social skills and patterns of behavior that may help them lead happier and more productive lives.

A third type of prevention, tertiary prevention, involves efforts to minimize the long-term harm stem­ming from mental disorders. Such programs are especially helpful for persons who are released from state facilities after years of confinement. One such program, Training in Community Living, attempts to repair the damage done by long years of what may amount to custodial care by teaching former mental-hospital patients the skills they need to live out in the community.

The former patients are provided with living quarters and are visited every week by program staff. In other words, they are out in the community but are living in a protected environment, where they can learn the skills they need for an independent life.

In sum, efforts at preventing or minimizing the harm of mental disorders do often seem to be quite effective. Their goal—like that of all forms of therapy—is reducing human suffering; but by operating before serious disorders occur, such programs take full advantage of the wisdom in the old saying “An ounce of prevention is worth a pound of cure.”

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Essay , Psychology , Mental Disorder , Essay on Mental Disorder

Home — Essay Samples — Nursing & Health — Mental Health — The Importance of Mental Health Awareness

The Importance of Mental Health Awareness

• Categories: Mental Health Social Isolation Stress Management

About this sample

Words: 1622 |

Updated: 4 November, 2023

Words: 1622 | Pages: 4 | 9 min read

Table of contents

Introduction, mental health awareness, video version, emotional well-being, psychological well‐being, social well-being.

• Health Effects of Social Isolation and Loneliness. (n.d.). Retrieved from https://www.aginglifecarejournal.org/health-effects-of-social-isolation-and-loneliness/.
• Top of Form Mental Health Myths and Facts https://www.mentalhealth.gov/basics/mental-health-myths-facts
• Mental Health Care Services by Family Physicians Position Paper. American Academy of Family Physicians Web site. http://www.aafp.org/online/en/home/policy/policies/m/mentalhealthcareservices.htm. Accessed February 11, 2013. [Google Scholar]
• Newman, T. (2017, August 24). Mental health: Definition , common disorders, and early signs. Retrieved from https://www.medicalnewstoday.com/articles/154543.php.
• Bottom of Form Rodriguez, B. D., Hurley, K., Upham, B., Kilroy, D. S., Dark, N., & Abreu, E (n.d.).Happiness and Emotional Well-Being. Retrieved from https://www.everydayhealth.com/emotional-health/understanding/index.aspx.
• World Health Organization. The Global Burden of Disease, 2004 Update. Part 4, Burden of Disease, DALYs. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf . Accessed January 10, 2013. [Google Scholar]

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Treatment, Symptoms, and Prevention of Bipolar Disorder Essay

Introduction.

Bipolar disorder is a mental disorder that is manifested by drastic mood changes — bipolar manifests in two main extremes, namely depression, and mania (Peacock, 2000). Depression manifests when an individual feels tired and sad. On the other hand, mania manifests when an individual experiences periods of extreme excitement and restlessness. Symptoms of bipolar depend on the extreme that individual experiences at a certain period.

In many cases, an individual is diagnosed with clinical depression and later with bipolar. During an episode of depression, individuals experience feelings that include hopelessness, extreme sadness, worthlessness, lethargy, and irritability (Peacock, 2000). In severe cases, an individual might contemplate suicide. On the other hand, episodes of mania are characterized by feelings of happiness, joy, irritability, and extreme creativity.

Prevalence and incidence

According to the World Health Organization, more than 10 million individuals have bipolar in the United States (Peacock, 2000). The disorder is a leading cause of disability in the world. It has a lifetime prevalence of approximately 3% around the globe. Statistics have revealed that more than 0.8% of the American population experiences at least a manic episode at one time in their life.

On the other hand, 0.5% of the population experiences a hypomanic episode. 6.4% of the American population has been shown to have bipolar spectrum disorder (Peacock, 2000). Studies have revealed that the incidence of bipolar disorder among men and women is the same. The incidence rate is similar across people of different origins and ethnic backgrounds.

However, its severity varies across the world. In the U.S., the rate of incidence is higher among African Americans than among Americans of European descent (Peacock, 2000). The disorder affects people mainly in their adolescence and early adulthood years. In many cases, individuals with experienced bipolar episodes of mania after the age of fifty.

Symptoms of bipolar disorder depend on the mood that an individual experiences at a certain period. Individuals experience extreme mood changes that affect their behaviors and thinking patterns. Mania is characterized by over-excitement, while depression is characterized by extreme sadness.

During episodes of depression, individuals experience feelings of sadness, hopelessness, worthlessness, and loss of interest in activities they previously enjoyed, such as sex and social interaction (Fink & Kraynak, 2012). Their thinking is predominantly negative, and they rarely see the positive aspects of their lives. Their behavior also changes. They are restless, irritable, indecisive, and insomniac. Moreover, they experience problems with concentration and memory (Peacock, 2000).

Symptoms of mania

Symptoms of mania include hyperactivity, high quantities of energy, extreme irritability, impulsive behavior, restlessness, risk-taking, extreme happiness, and excitement, as well as unrealistic belief in personal capabilities (Fink & Kraynak, 2012).

Hypomania is a less severe form of mania that is characterized by moderate productivity and happiness. In other cases, both episodes of depression and mania might manifest at the same time. During such episodes, individuals become insomniac, agitated, and may harbor sundial thoughts (Fink & Kraynak, 2012).

Treatment of bipolar disorder includes us of both medication and therapy (Miklowitz, 2011). Bipolar is a disorder that affects individuals for the rest of their lives. Therefore, combining medication with therapy lowers the prevalence of the various mood changes associated with the disorder (Fink & Kraynak, 2012).

The recurrence of a maniac and depressive episodes makes life difficult for victims. Successful treatment of bipolar disorder involves the use of different treatment remedies. According to studies, medication alone is not enough to treat bipolar disorder effectively. One of the most important aspects of bipolar treatment is education and awareness about causes and ways of management.

Victims should read extensively about the disorder, join support groups, and make lifestyle changes that enable them to manage their symptoms (Ketter, 2007). The most common treatment methods for bipolar include medication, psychotherapy, education, lifestyle changes, and support. Drugs such as mood stabilizers aid in the minimization of symptoms. The most common and most effective mood stabilizer used to treat bipolar is lithium (Ketter, 2007).

Antidepressants such as Prozac and Amitriptyline are also used. Antipsychotic medications include Ariplazole, Quetiapine, Risperidone, and Clozapine (Ketter, 2007). Other drugs used together with mood stabilizers include Lamictal, Symbax, Zyprexa, and Seroquel. Psychotherapy teaches individuals different ways of coping with difficult times and different mood changes (Fink & Kraynak, 2012). Types of therapy available to individuals include cognitive-behavioral therapy and family-focused therapy (Ketter, 2007).

Education involves understanding the various symptoms of bipolar and their management. Finally, support involves interacting with individuals with the disorder for moral, emotional, and psychological support. Support groups facilitate the sharing of experiences that could be helpful to other individuals with similar challenges (Ketter, 2007). Complementary treatments include acupuncture, deep meditation, as well as light and dark therapy.

Prevention of a bipolar disorder

To prevent bipolar disorder, it is important to learn about it to control mood changes and other symptoms. It is also important to practice lifestyle management. Lifestyle management involves changes such as alcohol avoidance, practicing meditation, physical exercise, and thinking positively (Miklowitz, 2011).

Prevention of bipolar disorder mainly focuses on stress reduction. High levels of stress increase the risk of developing bipolar for genetically susceptible individuals. Stress reduction can be achieved through regular physical exercise and participating in relaxation methods such as meditation and yoga (Ketter, 2007).

Risk factors

Bipolar disorder’s risk factors include genetics, lifestyle, alcohol and drug abuse, high-stress levels, environment, and major life changes. Research has revealed that bipolar disorder has a basis in the genes of individuals. Therefore, the risk is very high for individuals who come from families with a history of the disorder. Research has shown that children from families in which one or both the parents have the disorder have a high risk of developing the disorder (Fink & Kraynak, 2012).

Major life changes such loss of a loved one, sexual abuse, or traumatic events such as accidents increase the risk of developing the disorder. Individuals who undergo prolonged periods of stress are also at high risk of developing the disorder (Fink & Kraynak, 2012). Medical practitioners recommend physical exercise and meditation as two of the most effective methods of reducing stress. Alcohol and drug abuse also increase the risk of developing the disorder.

Environment plays a critical role in the development o bipolar disorder. For instance, children who grow in abusive and violent families have a very high risk of developing bipolar (Miklowitz, 2011). Stressful environments play a key role in triggering depressive episodes that herald the development of bipolar.

Diagnosis is carried out through evaluation by a medical professional following diagnosis guidelines as provided in the Diagnostic and Statistical Manual of Mental disorder (DSM) (Fink & Kraynak, 2012). Successful diagnosis is mainly based on the observation of major changes in mood patterns and behavior. After a successful diagnosis, a patient is given medication based on past medical history and the severity of the condition.

Bipolar disorder is a mental disorder that is characterized by extreme mood changes that range from mania to depression. Risk factors include lifestyle, genetics, environment, drug and alcohol abuse, and major life changes such as death or abuse. Symptoms depend on the type of mod. Symptoms observed during the mania phase include hyperactivity, risk-taking, restlessness, and unrealistic belief in one’s capabilities.

During the depression phase, symptoms include insomnia, poor concentration, lack of appetite, loss of interest in activities that were once enjoyable, and feelings of hopelessness as well as helplessness. In severe cases, individuals contemplate suicide. Effective treatment involves the use of both drugs and psychotherapy. Drugs used include mood stabilizers, antidepressants, and psychotic medication.

Forms of therapy applied to include cognitive-behavioral therapy, family-centered therapy, as well as interpersonal and social rhythm therapy. Prevention involves participation in physical exercise and stress reduction activities such as meditation and yoga. According to the World Health Organization, more than 10 million individuals have bipolar in the United States.

On the other hand, 3% of the world’s population suffers from the disorder. Research has revealed that bipolar disorder has a basis in the genes of individuals. Therefore, the risk is very high for individuals who come from families with a history of the disorder. Research has shown that children from families in which one or both the parents have the disorder have a high risk of developing the disorder.

Fink, C., & Kraynak, J. (2012). Bipolar Disorder for Dummies . New York: John Wiley & sons.

Ketter, T. (2007). Advances in Treatment of Bipolar Disorder . New York: American Psychiatric Publishers.

Miklowitz, D. J. (2011). The Bipolar Disorder Survival Guide, Second Edition: What You and your Family Need to Know . New York: Gilford Press.

Peacock, J. (2000). Bipolar Disorder . New York: Capstone.

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IvyPanda . "Treatment, Symptoms, and Prevention of Bipolar Disorder." April 5, 2020. https://ivypanda.com/essays/bipolar-disorder-essay/.

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This section is dedicated to argumentative and persuasive essays on mental health awareness in the United States. Mental illness and psychological problems are social issues that require a solution. A student can represent their point of view and perspective through an argumentative essay about mental health. What causes this problem and which is the solution would be perfect subjects for this type of paper.

It’s always a challenging task for students to reflect on illnesses, so to get a hint on how to start writing, you can look at the thesis statement and research paper samples on mental health on our website.

As often, start with a coherent introduction, outline, and title planning the structure of a paper. Consult research essay topics and argumentative topics if necessary.

Having studied all the samples, topics for ideas, and mental illness essay examples compose the main part, giving reasons for the mental diseases, ways to cure them, and arguments on why a mental illness should be considered a severe health problem.

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How To Write An Essay On Mental Health

Introduction to mental health as an essay topic.

When writing an essay on mental health, it's essential to understand its complexity and significance in today's society. Mental health refers to the state of our emotional, psychological, and social well-being. It affects how we think, feel, and act, and it also helps determine how we handle stress, relate to others, and make choices. In your introduction, define mental health and its importance in maintaining overall well-being. Clarify the specific aspect of mental health you plan to explore, whether it's discussing a particular mental disorder, examining the impact of mental health on various life aspects, or analyzing mental health policies. This introduction should provide a clear context for your essay and highlight its relevance.

Exploring the Various Aspects of Mental Health

Dedicate the main body of your essay to a thorough exploration of your chosen aspect of mental health. If focusing on a specific mental disorder, discuss its symptoms, causes, and treatment options. For a broader approach, you might analyze the factors that contribute to good or poor mental health, such as genetics, environment, lifestyle, and societal influences. Include current research and statistics to back up your points and provide a comprehensive understanding of the topic. Remember to handle the subject with sensitivity and empathy, especially when discussing conditions that may affect your readers or their loved ones.

Addressing Challenges and Misconceptions

Another critical aspect of your essay should be addressing the challenges and misconceptions surrounding mental health. Discuss the stigma often associated with mental illness and its impact on individuals seeking help or treatment. Examine the barriers to accessing mental health care, such as cost, lack of resources, or cultural attitudes. You can also explore common misconceptions about mental health and how they hinder societal understanding and support for those affected. This section is crucial in shedding light on the obstacles faced in the realm of mental health and advocating for a more informed and supportive approach.

Concluding with the Importance of Mental Health Awareness

In your conclusion, summarize the main points discussed in your essay and reflect on the significance of mental health awareness and support. Emphasize the need for open dialogue, education, and comprehensive care to promote mental well-being. Discuss how increasing mental health awareness can benefit individuals and society as a whole, leading to a more empathetic and healthier community. Your conclusion should not only tie together your analysis but also inspire readers to recognize the importance of mental health and advocate for better support and resources in their communities.

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Introduction To Mental Health

• Category Health
• Subcategory Mental Health

In this essay, I will be describing how I have been developing my understanding of Mental Health Nursing over the course of the module Introduction to Mental Health, by discussing the different topics I have been researching and learning throughout this module to achieve my level of understanding. The key points I will be discussing are, the history of mental health, the definition of mental health and illness, the roles and responsibilities of the Mental Health Nurse, the quality skills of the Mental Health Nurse, different models of mental health and illness, recovery, and the stepped care model.

I am developing an understanding of Mental Health Nursing within this module by learning what mental health and mental illness are defined as, the history of mental health , the diverse range of roles and responsibilities of the Mental Health Nurse and the qualities required to fulfil these roles effectively, the process of recovery that considers the variety of models of mental health and illness that are used to achieve individual recovery, and the stepped care delivery model.

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The history of mental health began with the term keeper and attendants of the insane whose role it was to control and maintain the order of the inmates within the institutions that had been built to house them, to then the term nurse slowly being introduced. Asylums were then slowly becoming phased out largely due to overcrowding, with some of the patients being incarcerated due to lack of wealth or social status. Mental health then progressed to defining mental health as an actual illness, they then slowly started closing the institutes. As the institutes began to close, patients were then discharged back into the community, and home-based support was more widely introduced. (Nolan, 1993)

Mental illness is defined as a range of mental health conditions that may affect someone’s thoughts, emotions, moods and ability to relate to others and function daily. People with the same diagnosis will each have different experiences of the condition. (Bolton, 2008)

With consideration to the fact each individual may have a different experience of their condition, the recovery process for each person will vary, therefore the roles and responsibilities of the Mental Health Nurse will vary within the recovery process, as each individual has a different perception of what recovery may mean for them. The roles may be that of a carer, educator, custodian, therapist, advocate, role model, inspirer of hope, milieu manager, leader, researcher, assessor, advocate, supporter, listener, risk-taker or care coordinator. (Egan, 2010)

In order to fulfil these roles effectively, the Mental Health Nurse must have the professional quality skills to be able to assist within the recovery by having good listening skills, good communication, be professional, be understanding, show kindness, empathy, adaptability, sincerity, calmness, and the ability to think critically and creatively, good skills and knowledge, humour, to be a rational thinker, problem solver and many more. (Clifton et al., 2017)

The notion of recovery from mental health problems considers a variety of different models of mental health and illness, while some of these models don’t speak of recovery, they help us to better understand mental distress to aid in individual recovery.

The Humanistic model, that is also known as person-centred care, is where the practitioner works with the client to determine a better understanding of the issue, to help support the individual in finding what they believe the problem and solution maybe, rather than make assumptions of the individual. The person-centred approach is underpinned by the core values of empathy, unconditional positive regard and congruence (Clifton et al., 2017)

The Biopsychosocial model investigates the biological, cognitive, psychological and social factors that may have an impact on an individual’s wellbeing, such as physical health, metabolic disorders and emotions, coping skills and social skills, peer groups, interpersonal relationships, trauma, grief and perceptions. These factors highlight the effects all these interactions may have on an individual’s health and wellbeing, rather than assume only one factor may be the cause. (Clifton et al., 2017)

The Stress Diathesis model outlines that stress levels, and each individual’s level of ability to cope with stress, may contribute or cause mental illness, which explains why some people may be exposed to the same level of stress but react differently to those stressors, and it is the Mental Health Nurses responsibility to try and help them find better ways to manage and cope with these stresses to aid in the recovery process. (Zubin and Spring, 1977)

The main principles within the recovery process are hope, and the ability to learn to understand their condition to be able to take back control of their lives, whether that be building resilience or social inclusion such as finding local support groups to be able to flourish rather than merely survive. (Repper and Perkins, 2003)

In order to structure and deliver these models and principles within mental health, we use the stepped care model, this is a model of service delivery, this is a system of delivering the care to the patient using the least resources but with the maximum effect and reach to patients, with the main principles of delivering the best care with minimum impact on the individual, and detecting the need for more or less intensive treatment, allowing them to step up, step down or step out of treatment if an alternative treatment may be more beneficial for them, step up could be a referral from a primary care team to the secondary care team, with each successive step up process being a more intensive treatment, step down such as from speciality care team to a secondary care team or to step off to self-care, telephone appointments or social inclusion interventions. (Firth, Barkham and Kellett, 2015)

In conclusion, mental health has advanced significantly over the history of nursing to achieve a diverse range of professional support, particularly advances towards support within the community, and that mental illness is defined as a range of mental health conditions. That everyone’s experience of mental health conditions will differ, even with the same diagnosis. To be able to support and treat those mental health conditions, the Mental Health Nurse has a variety of roles and responsibilities to fulfil and have the right professional qualities to achieve support and recovery. Recovery is individual, each person has a different perception of what recovery means for them and the way to achieve this. Mental Health Nurses must apply a variety of models to mental health conditions and illnesses, that looks at a person centred approach, the biology of the individual and the stress vulnerability of the individual, to discover the impact that these may have on their wellbeing, to support them towards their recovery process, and be able to take back control of their lives. A service delivery model, the stepped care model, is used to direct an individual to the right level of care within healthcare, where they can step up, step down or step out of the intensity of the care, with minimal impact on their lives.

I will take this learning forward in my nursing practice by maintaining a person-centred approach, and by applying the models of mental health and illness to everyone I am supporting to be able to achieve the best outcomes of recovery, and by remembering that each person has a different perception of what term recovery may mean for them.

• Bolton, D. (2008). What is Mental Disorder: An Essay in Philosophy, Science and Values. United States: Oxford Press, p.Chapter 1.
• Clifton, A., Hemingway, S., Felton, A. and Stacey, G. (2017). Fundamentals of Mental Health Nursing. John Wiley & Sons, Incorporated, p.Chapter 1.
• Clifton, A., Hemingway, S., Felton, A. and Stacey, G. (2017). Fundamentals of Mental Health Nursing. John Wiley & Sons, Incorporated, p.Chapter 3.
• Egan, G. (2010). The Skilled Helper. 9th ed. Linda Schreiber: Cengage, p.chapter 1.
• Firth, N., Barkham, M. and Kellett, S. (2015). The clinical effectiveness of stepped care sysyems. Journal of Affective Disorders, [online] (170), pp.119-130. Available at: http://www.elsevier.com/locate/jad
• Medlineplus.gov. (2019). Mental Disorders: MedlinePlus. [online] Available at: https://medlineplus.gov/mentaldisorders.html
• Nolan, P. (1993). A History of Mental Health Nursing. London: Stanley Thomas, pp.chapter 1, 1.2.
• Repper, J. and Perkins, R. (2003). Social inclusion and recovery. Edinburgh: Baillière Tindall, pp.1-63.
• Zubin, J. and Spring, B. (1977). Vulnerability- A new view of schizophrenia. Journal of Abnormal Psychology, 86(2), pp.103-126.
• Linzi Morgan 1904643

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Mental Illness Essay

Type of paper: Essay

Topic: Health , Psychology , Medicine , Family , Disease , Illness , Disorders , Mental Illness

Words: 2475

Published: 2021/01/07

Introduction

Mental illness is any condition or disease that influences the way a person feels, thinks, behaves and relates to others and the surroundings. It can either be mild like in some depressions where things seems worse than they are, or very severe like when a person life is dominated by an illness making them not live independently(Keyes, 2013). The exact cause of mental health disorder is not known, but research has revealed a combination of causes ranging from, biological, genetic, environmental and psychological factors. It has been estimated that mental illness will affect one person among four in a day to day life.Mental illnesses can be prevented using simple preventive measures, but it still remains a serious global health challenge Some mental illnesses are caused by psychological trauma from early childhood like severe physical and emotional abuse, sexual abuse, and loss of a loved one. Genetic mental illness runs in the family and is passed from a parent to the child through genes. Hereditary mental illness is triggered by other factors like environmental stressors and psychological trauma. Certain stressors like death, divorce, loss of a job and substance abuse may trigger the disorder in persons at risk. Other mental illnesses are linked to abnormal brain chemicals which aid nerve cells in communicating with the brain(Thornicroft, Ruggeri & Goldberg, 2013). The common types of mental illness include; mood disorders, eating disorders, psychotic disorders, personality disorders, anxiety disorders, post-traumatic disorders and obsessive compulsive disorder. Persons with personality disorders have extremely inflexible traits that are distressing to the person and cause problems in their relationships. Psychotic disorder is distorted thinking and awareness; it is diagnosed by two symptoms; delusions-false beliefs and hallucinations-images and sounds that are not real. Moods disorders are fluctuations from extreme sadness to extreme happiness, and they include bipolar, depression and cyclothymic disorder. Individuals who havepanic disorder present with fear, sweating and rapid heartbeat(WHO, 2011).

Symptoms of Mental Illness

Anxiety is a symptom of mental illness that differs from normal stress as it is long lasting and severe. It is characterized by increased heartbeat, sweating, flushing, headache, choking nausea, vomiting, shortness of breath and dizziness. Psychological effects of anxiety include; vivid dreams, confusion, sleep disturbances, mind racing, decreased concentration, excessive worry and fear irritability, impatience, anger and confusion. The individual tends to have a phobic behaviour, compulsive and obsessive behaviour, distress and avoidance of social situations. Prolonged anxiety may lead to depression and later psychotic condition(Graham, 2013). Depression is one symptom of mental illness lasting for at least two weeks and affects person’s thinking, emotion, physical and behavioural wellbeing. Emotional symptoms include sadness, guilt, anger, helplessness, hopelessness, mood swings and anxiety. Physical symptoms in depressed individual consist of loss of sex drive, weight gain or loss, reduced appetite or overeating, menstrual cycle change, constipation, lack of energy, chronic fatigue, too much or loss of sleep(Hill, Mann &Fitzgerald, 2011). Behavioural symptoms of depression include; drug or alcohol abuse, withdrawal from others, worrying, crying spells, no interest in personal appearance and loss of motivation. Psychological symptoms consist of; impaired concentration and memory, confusion and indecisiveness, self-blame, self-criticism, thoughts of suicide and death(Jongsma, Berghuis& Bruce, 2014). Some individuals with mental illness may inhibit manic symptoms. These include; increased overreacting and activity, lack of insight, elated moods, rapid speech and thinking, grandiose delusions and sleep disturbance. It may lead to change of perception and thinking, hallucinations, crying spells and inappropriate emotions(Thornicroft, Ruggeri & Goldberg, 2013). These symptoms may indicate bipolar disorder or psychotic disorder. Individuals tend to be in denial of their status and may overreact if they are told of what they are suffering.

Prevention Methods

Primary prevention methods are used in preventing occurrence of a disease or disorder. It targets groups and individuals who are at a high risk of developing a mental illness based on social, psychological and biological factors. Primary prevention programs include providing support to children whose parents are facing divorce, distributing condoms and teaching teenagers who are at risk of pregnancy or teaching parents on effective parenting skills. D.A.R.E (Drug Abuse Resistance Education) is an international primary preventive program known in reducing substance abuse among the youths. This program has been known to impact knowledge on youths on drugs and the ways to cope with addiction(Thornicroft, Ruggeri & Goldberg, 2013) Mental disorders are linked to human rights. Human rights violation, discrimination and stigma to individuals and families of mental ill individual are intense. The phenomenon represents the consequences that no treatment or preventive measures are existing. Effective preventive measures can change the way society and individuals perceive mental disorders. Many effective measures used are harmonious with principles of equal opportunity, care and social equity of vulnerable group(Jongsma, Berghuis& Bruce, 2014). The common threat of fighting with mental illness is violence and conflict between countries and communities. Evidence-based prevention is a proven laboratory programme in varying resource and cultural settings. Cultural applicability has made dissemination of these prevention measures slow and complicated. The aim of mental disorder prevention is reducing recurrence, incidence, prevalence, reducing the risk of the condition and impact of the illness on the family, society and the affected person. Mental health promotion promotes a positive attitude by increasing by increasing psychological resilience, well-being and competence, by creation of supporting the environment and living conditions(WHO, 2011). Mental disorder prevention reduces symptoms of the mentally ill. Health promotion and evidence- based prevention is a judicious, explicit and conscientious use of recent best evidence in making decisions about interventions for communities, populations and individuals which facilitate best outcomes in reducing incidence of disease by helping people to increase control and improve their health(Link & Phelan, 2014). Both solid standard and scientific evidence are required to avoid invalid conclusions to outcomes through the interventions. Protective factors in mental illnessare conditions that improve individual resistance to disorders and risk factors. Mostly, protective factors for individuals are identical on features of mental health and include; self-esteem, positive thinking, emotional resilience, stress management skills, and problem-solving(WHO, 2011). Family related and individual protective and risk factors can be emotional, biological, behavioural, cognitive, family related and interpersonal. These factors have the strongest impact on individual mental health during the sensitive period in a lifespan, and the impact is extended to generations. For example, mental illness during childhood, infancy and child abuse may lead to anxiety and depression later in life while social support and secure attachment reduce the effects(Graham, 2013). Improved nutrition has been linked to improved educational outcome, cognitive development and reduced mental illness risk. The effective interventions include; growth monitoring and complementary feeding especially to children living in the impoverished communities. The models combine prevention with psychosocial care like attentive listening and warmth, nutritional interventions and counselling(Thornicroft, Ruggeri & Goldberg, 2013). Poor housing is an indicator of poverty, improving houses is linked with the reduction of health inequalities and improves public health. Recent review on how housing affects health has shown an impact on mental and physical health outcomes. Improved housing reduces mental strains and increases positive social impact on safety perceptions, social, crime and community participation(Hill, Mann &Fitzgerald, 2011). Low educational and literacy levels limit many individuals from accessing economic entailments especially women and girls. Impacting education on girls and women helps in gained self-worth, pride and purpose(Graham, 2013). Depressive Symptomology may be reduced by strengthening protective factors found in populations. These may include school-based programmes that targeting problem-solving, social and cognitive skills among adolescents and children. Parental depression may be reduced by parenting interventions that help parents with children who has conduct behaviour by improving their psychosocial wellbeing through training them in behavioural childrearing strategies(Link & Phelan, 2014). There exist programmes for people with elevated depression, and they are taught on improving problem-solving skills, positive thinking and challenging negative thinking. Mentally ill patients who present with depression should be encouraged and enrolled in these support programmes(Jongsma, Berghuis& Bruce, 2014). Many traumatising events or exposure led to anxiety and depression. These preventable traumatising events include sexual assault, violence, child abuse, torture and war. The duration of exposure to a traumatising event works as an evidence-based determinant to the risk of psychiatric reactions and the way they respond to such events. Families and friends should help the mentally ill from any exposure to events that remind them of a painful past(WHO, 2011). The therapist during his session should help the infected and the affected to determine the causative event and any scene reminding him/her of the event should be avoided.

Factors Affecting Mental Illness

Factors that determine mental health include individual attributes and behaviours, social-economic circumstances and environmental factors. These three different determinants interact with each other or work individually against or of an individual’s mental status. For example, the individual level of self-worth could be diminished or enhanced depending on economic security or social support at household level that may intern be influenced by economic growth, social justice and political stability of a country. Individual’s mental health may be influenced by circumstances or event that occurred before their conception or birth. Pregnancies that take place during the adolescent or are unwanted increase the risk of mental health during childhood and ill behaviours during pregnancies like use of drugs (Novak &Syab, 2009) People with mental health problems experience difficulties in securing or maintaining a job. They experience social exclusion, violent victimization, human rights abuse and discrimination. Presence or onset of mental health disorder increases the chance of disability and premature mortality from diseases like HIV/AIDS, cardiovascular diseases, diabetes and other chronic illnesses. The causes of occurrences of the diseases to these individual include unhealthy diet, side effects of medication, diminished physical activity and neglected physical health (by caregivers, families and themselves)(Link & Phelan, 2014). Persons with physical and comorbid mental conditions are at high risk of infection from these diseases due to reduced health seeking behaviours, follow-up and adherence for these cases. Mental health disorders’’ prevalence has increased in work environment. Many employees are turning to be mentally ill either due to work or their personal life. Workplace should engage their employees in training that increase their mental health knowledge. For individuals with mental health problems, retaining, returning or finding employment in an open labour market is hard. The individuals are surrounded by stigma, and their recovery process is misunderstood by others(Rogers, & Pilgrim, 2009). The workplace contains a significant influence of human mental well-being. Traditionally, employers have concentrated on their employees’ physical health forgetting their mental health. Certain factors promote mental health and psychosocial well-being in the workplace. They include an opportunity to carry out activities, planning and making decisions. Any mentally ill individual in a workplace should be grant similar opportunities and responsibilities as others to increase his self-worth(Novak &Syab, 2009). Parents with babies and children who are mentally retarded hide them from friends, family and society. Many of these children do not attend therapy and are at elevated risk of premature death. This discrimination worsens their situation, and they view environment and society as their enemy. Lack of love and support from families and friends may increase chances of suicide. The society has a responsibility for protecting the affected children by accepting them whileparents, family and friends should love, support and accompany them during therapy(Dulmus&Nisbet, 2013).

Differences between Cares Approach and Self- Management

Patients should ensure that theyadhere to their doctor’s or therapist instructions. Family members have a responsibility in; ensuring drugs are taken at the right time, right dosage and support them during medication. The family supporter should be trained on ways of distinguishing and early detection of symptoms. The therapist should always be available during a call and ready to answer any question concerning the patient. Through this, the mentally ill person will be in control of his health and have confidence in the therapist(WHO, 2011). Support programs should be created where mentally ill patients together with their family support or care meet(Dulmus&Nisbet, 2013). During these settings, individuals will share their experience, coping strategies and future intentions of dealing with the ailment. Through this, patients will boost their confidence and self-esteem and will make friends who understand them better and are facing similar challenges. Trainings and physical activities like exercise should be incorporated to increase knowledge on ways to cope with the condition and how to detect symptoms(Novak &Syab, 2009). A friend or a family member should be involved during clinic visit. The mentally ill person should be helped in knowing the trigger of the symptoms. A plan should be drawn for him/her to know what to do in case the symptoms appear. Incase the symptoms appear, the individual should immediately contact his/her doctor or therapist. Check-ups and visits to the therapists should not be skipped because there may exist a new health problem and may be treated or any side effects of the medication being taken(Rogers, & Pilgrim, 2009). Long-term maintenance of mental illness prevents relapse. The individual should seek help when symptoms start showing up. A regular schedule on sufficient sleeping, regular physical exercise and healthy eating should be maintained. Consulting the therapist or doctor is recommended in case of trouble while sleeping, or the individual has questions on exercise and diet. Carers should also be trained on the best way to support and show love to the mentally ill individual. In suicidal patients, efforts should be taken to reduce any access to means of committing suicide. Counselling of individual with a history of suicide should be undertaken. During a counselling session, the cause for the act should be established, and it would be helpful in determining the actions forward. Incase of children, adolescents and young adults, parents and guardians should be counselled to help and support the victim in moving on and deleting suicidal thoughts in their minds. These individuals should be monitored in times when they are depressed and given support and medications when needed. Families should educate themselves about their loved one’s condition as foundation for support. The knowledge of the way an illness function is important in reducing misconceptions and helps the family to give the loved one an effective help(Graham, 2013). Families of mentally ill should be educated and involved in the treatment process as this reduces symptoms, relapse and hospitalization days. Through this, the families understand the mentally ill individual behaviour is due to the illness and not willful or their cause. The education provided increases love, understanding and care. Wellness Recovery Action Planning (WRAP) is a tool used for mental illness self-management. Studies have shown that self-management- or individual determination to manage illness, get better, face problems, take action and make choices, promote recovery frommental illness. WRAP is a program that participants identify externally and internal resources for facilitating recovery and use the tool to make their individual plan. The intervention helps in changing individual’s attitude and behaviour. Therapists are supposed to guide their clients in coming up with the plan and how to use it(Keyes, 2013). Mental illness over the past years has erupted as a public health importance. It is a preventable and manageable disorder at primary, secondary and tertiary levels. Changing factors that increase its susceptibility is mandatory. The society, family and environment should accommodate the mentally ill and give them the opportunity to enjoy life without discrimination. The caregivers should be in a position of identifying symptoms at early stages and managing them on their onset.

Dulmus, C. N., &Nisbet, B. C. (2013).Person-centered recovery planner for adults with serious mental illness. Hoboken, New Jersey: John Wiley & Sons, Inc. Graham, G. (2013). The disordered mind: An introduction to philosophy of mind and mental6 illness. New York City, NY: Routledge. Hill, N. E., Mann, T. L., & Fitzgerald, H. E. (2011).African American children and mental health. Santa Barbara, Calif: Praeger. Jongsma, A. E., Berghuis, D. J., & Bruce, T. J. (2014). The Severe and Persistent Mental Illness Treatment Planner. Hoboken: Wiley. Keyes, C. L. M. (2013). Mental well-being: International contributions to the study of positive mental health. Dordrecht: Springer. Link, B. G., & Phelan, J. C. (January 01, 2014). Mental Illness Stigma and the Sociology of Mental Health. Novak, L., &Švab, V. (January 01, 2009). Antipsychotics side effects' influence on stigma of mental illness: Focus group study results. 1st Croatian Congress on Side Effects of Psychotropics with International Participants, 21, 1, 99-102 Rogers, A., & Pilgrim, D. (2014).A Sociology Of Mental Health And Illness. Maidenhead: McGraw-Hill Education. Thornicroft, G., Ruggeri, M., & Goldberg, D. P. (2013).Improving mental health care: The global challenge.Chichester, West Sussex: Wiley-Blackwell World Health Organization.(2011). Mental health atlas 2011. Geneva: World Health Organization

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Guest Essay

What Martin Luther King Jr. Knew About Crime and Mental Illness

By Alvin L. Bragg Jr.

Mr. Bragg Jr. is the Manhattan district attorney.

In September 1958, the Rev. Dr. Martin Luther King Jr. was stabbed with a seven-inch steel letter opener. He had been autographing copies of his first book in Blumstein’s department store in Harlem. The woman who stabbed him was named Izola Ware Curry .

When Dr. King found out she was schizophrenic, he harbored no ill will toward her , saying instead, “I know that we want her to receive the necessary treatment so that she may become a constructive citizen in an integrated society where a disorganized personality need not become a menace to any man.”

Dated description aside, King recognized that people in crisis need mental health care to be healthy and safe. The many Izola Ware Currys in New York today are far more likely to find themselves in jail, or relegated to street corners and subway stations, than they are to receive comprehensive treatment. This disconnect can set the stage for people with mental illness to be both victims and perpetrators of real violence.

Mental illness isn’t a crime, and jail isn’t the answer for those experiencing it. We must meet the needs of people in crisis with treatment and support. In order to do so, we need more funding.

Lawmakers in Albany right now are in the final stages of negotiating our state budget. Gov. Kathy Hochul and the leaders of the Senate and Assembly must make good on their earlier support for significant investments in mental health care — especially for New Yorkers who have been struggling, posing potential dangers to themselves and others. Doing so now can reduce assaults in our city by people experiencing mental health crises. They can also ensure that when those people do commit crimes, they are held accountable in a manner that reduces recidivism.

Around half of people in New York City jails — some 3,000 men and women — have been diagnosed with some degree of mental illness. On any given day, hundreds await evaluations or beds at dwindling and overwhelmed state psychiatric hospitals . On a typical day at Manhattan Criminal Court, you’ll witness the churn of people struggling with mental illness, caught up in a cycle of recidivism and incarceration instead of receiving the therapy, medication and other services that would help them lead healthy, productive lives.

And it’s not only New York. According to the Vera Institute of Justice, in the United States, people with serious mental illness are more likely to encounter law enforcement than they are to receive treatment . Since the 1950s, around the time King barely dodged death, the number of state hospital psychiatric beds has decreased by around 94 percent. In many cases, jails and prisons filled the void. While large-scale psychiatric institutionalization was far from perfect — to say the very least — meaningful community-based alternatives never materialized.

Today, corrections facilities double as de facto mental health hospitals across the nation — and about 63 percent of those with a history of mental illness do not receive treatment while incarcerated in state and federal prison.

But it is in New York City where the failed mental health system seems to be on starkest display.

Desperate scenes of people in clear distress on subway platforms, in city parks and on bustling street corners, are commonplace. And although overall crime is down , the city has witnessed terrifying acts of violence and alarming incidents of disorder. Innocent people shoved in front of oncoming trains is a citywide nightmare. Women fear being randomly punched while walking down the street. This is a humanitarian disaster, and a public health and safety crisis.

We must do better — for those with real and complex mental health needs, and for all New Yorkers who currently fear for their safety. But attaining a comprehensive mental health system won’t happen overnight.

In the past few years, I’ve committed $9 million to two programs, Neighborhood Navigators and Court Navigators . In both programs, individuals with lived experience — designated “navigators”— help guide our struggling neighbors through the complex landscape of social services. It’s a start, but so much more is needed.

This year’s state budget is another opportunity to continue to build New York’s mental health infrastructure. My office submitted a detailed proposal to Albany leaders outlining mental health investments that are urgently needed this year. If we fail to take systemic action, New Yorkers will continue to confront daily scenes of desperation, and risk falling victim to shocking — but not surprising — acts of arbitrary violence.

Most directly related to the work of the Manhattan district attorney’s office, I’ve asked Albany to invest at least $25 million to expand and strengthen New York’s problem-solving courts. Such courts provide precisely the kind of treatment options that King may have wanted for his attacker, but that did not exist then. In exchange for pleading guilty, participants are offered court-supervised treatment instead of incarceration.

If they comply with their treatment plan and avoid rearrest (typically for 18 to 24 months), their felony plea can be reduced to a misdemeanor or dismissed. One mental health court found that it reduced the likelihood of rearrest by 46 percent.

I also urged Albany leaders to fund community-based mental health treatment, investing $16.3 million to fund 20 new teams to provide support to justice-involved individuals with serious mental illness. Similar initiatives have been shown to reduce overall recidivism .

For those who cannot be safely diverted from incarceration to treatment in the community, Hope House , which recently broke ground in the Bronx, will soon offer a safe and humane alternative to the Rikers Island jail complex, with 24-hour security and therapeutic treatment. The state should commit $30 million in capital funding to scale up the Hope House model.

Supportive housing provides essential stability to those with mental illness who have been justice-involved. Thousands of individuals returning to New York City from state prison go straight to shelters. Homelessness increases the risk of incarceration, which in turn increases the risk of homelessness. To break this vicious cycle, Albany should invest in building 500 new re-entry apartments over the next three years, and should expand an existing housing program for people leaving city jails.

Since I took office, we have made substantial progress in driving down murders and shootings in Manhattan, but the rise in felony assaults remains a persistent challenge. To reverse the post-Covid rise in random assaults of and by people with untreated mental illness, prevention-oriented investments are critical; enforcement has little deterrence value for crimes committed by those experiencing a mental health crisis.

Following his brush with death at the hands of Izola Ware Curry, King recognized treatment as the best path to keep those with mental illness, and those around them, safe. With assaults like the one King suffered becoming more common, our leaders in Albany must heed his call today and invest in a comprehensive mental health network.

Now is the time for action to address our mental health emergency.

Alvin L. Bragg Jr. is the Manhattan district attorney.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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OPINION article

Potential roles of gangliosides in chemical-induced neurodegenerative diseases and mental health disorders.

• 1 Department of Pharmacology and Toxicology, Medical College of Georgia at Augusta University, Augusta, GA, United States
• 2 Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States

1 Introduction

The prevalence of neurodegenerative diseases and mental disorders have been increasing over the past few decades. While genetic and lifestyle factors are important to the etiology of these illnesses, the pathogenic role of environmental factors, especially toxicants such as pesticides encountered over the life span is receiving increased attention. In addition, some toxicants have been utilized as chemical warfare agents and they may pose a greater risk to human health than biological weapons because of easier access. Chemical warfare agents have been used in World War I and II, the Iran-Iraq War, and other more recent conflicts in the Middle East. Toxic chemicals have also increasingly attracted the attention of terrorists, since these weapons have potentially devastating effects on the general population. As an example, the Japanese terrorist cult Aum Shinrikyo released the nerve agent sarin in the Tokyo subway in 1995 killing 13 people and causing more than 5,800 people to seek medical attention. In addition, there have been a number of accidental toxicant exposures during storage and shipments of hazardous chemicals over the years including a recent example, the Ohio train derailment in 2023. It is thus important to establish more effective medical countermeasures to improve recovery from toxicant exposures to counter an ever present environmental health concern ( National Toxicology Program, 2019 ; Reddy, 2024 ).

Among the toxicants found in many pesticides and chemical warfare agents, the chemicals known as organophosphates are most frequently associated with adverse long-term neurological consequences ( Figueiredo et al., 2018 ; Naughton and Terry, 2018 ). Organophosphates are defined as any organic compound whose molecule contains phosphate ester groups. In addition to pesticides and chemical warfare agent organophosphorus compounds have been utilized as fuel additives, plasticizers, flame retardants, lubricants, and pharmaceuticals. Their primary mechanism of acute neurotoxicity is based on the irreversible inhibition of acetylcholinesterase which is the major enzyme responsible for hydrolysis of acetylcholine in the cholinergic synapse. In the body, acetylcholinesterase prevents overstimulation of postsynaptic neurons by reducing levels of acetylcholine available to the cholinergic receptor. However, as a result of organophosphorus exposure, the breakdown of acetylcholine is prevented, resulting in a state of sustained excitation of cholinergic receptors. Organophosphate chemical agents cause severe convulsions and seizures, leading to severe damage of the central nervous system (CNS). Antidotal therapy is available to combat the symptoms of acute organophosphate toxicity, however, there are no established interventions for the long-term neurological consequences of organophosphate exposure. It is thus highly desirable to better understand the mechanisms by which these chemical agents affect the nervous system chronically and lead to dysfunctional neuronal activity.

In the nervous system, lipids are the most abundant organic compounds, and a variety of lipids control the biophysical nature of lipid membranes. Glycosphingolipids are a class of lipids that are unique amphipathic molecules with a hydrophilic carbohydrate portion and hydrophobic lipid component. Gangliosides are sialic acid-containing glycosphingolipids known to play essential roles in cell-cell recognition, adhesion, signal transduction, and cellular migration, and that are crucial in all phases of neurogenesis ( Itokazu and Yu, 2023 ; Itokazu et al., 2023 ). Mice lacking major glycolipids show lethal phenotypes, indicating the significance of glycolipids to mammalian physiology. Moreover, patients with ganglioside deficiencies exhibit severe clinical phenotypes and altered glycosphingolipid expression has been associated with neurodegenerative diseases and mental health disorders. It is also important to note that alterations in glycolipid composition after organophosphate exposure in mammals and birds have been reported ( Rozengart and Taranova, 1969 ; Taranova, 1978 ; Islam et al., 1983 ; Khan and Hasan, 1988 ; Bush et al., 1995 ). Here we focus on the potential of glycolipids to protect and promote regeneration of the CNS in chemical-induced neurodegenerative diseases and mental health disorders as a therapeutic strategy.

2 Potential functions of gangliosides in chemical-induced neurodegenerative diseases and mental health disorders

2.1 toxic chemicals are associated with neurological and psychiatric disorders.

Multiple reports have made associations between environmental organophosphate exposure and neurodevelopmental deficits including impaired cognitive and neurobehavioral development, decreased intelligence quotient (IQ), and increased abnormal reflexes (reviewed, Jokanovic et al., 2023 ). Both prenatal and postnatal exposure to organophosphates have been associated with cognitive and attentional deficits as well as, attention deficit hyperactivity disorder (ADHD). Occupational exposure to organophosphates has also been associated with elevated levels of anxiety and depression in adults, although children were more sensitive to neurotoxicity caused by organophosphates during brain development. Organophosphorus ester-induced chronic neurotoxicity (OPICN) also called chronic organophosphate-induced neuropsychiatric disorder (COPIND) appears as a set of long-term, persistent, chronic neuropsychiatric symptoms including apathy, decreased visual memory, impaired vigilance, reduced abstract reasoning, anxiety, depression, increased social isolation, reduced fine motor coordination, confusion, dizziness, insomnia, reduced vibrotactile sensitivity, decreased academic skills, emotional lability, irritability, short-term memory deficits, decreased verbal attention, fatigue, problems with concentration, and slowing of reaction time. After single dose exposure to organophosphates in Japan in the Aum Shinrikyo terrorist attack, assault victims had eye-related symptoms, physical fatigue, numb muscles, headache, depressive mood, forgetfulness, and chronic lack of concentration for 5–10 years afterwards ( Kawana et al., 2001 ; Yanagisawa et al., 2006 ). Despite considerable research to investigate the association between these toxic chemicals and persistent neurological and psychiatric disorders, neuropathologic mechanisms of the long-term impairments by organophosphate exposure remain unclear.

2.2 The cholinergic system and neurological and psychiatric diseases

Acetylcholine is the neurotransmitter of the cholinergic system and it has an important role in memory, attention, motivation, novelty seeking and arousal. Dysfunction of the cholinergic system is clinically significant in several diseases and thought to play a major role, in Alzheimer's disease ( Terry and Buccafusco, 2003 ). Acetylcholine acts on two main types of receptors, nicotinic and muscarinic acetylcholine receptors. Neuronal nicotinic acetylcholine receptors (nAChRs) are expressed both pre- and post-synaptically in most regions of the brain ( Terry et al., 2023 ) and it has been reported that dysfunctional muscarinic and nicotinic receptors contribute to the symptoms of multiple neurologic and psychiatric illnesses in addition to AD and include, Parkinson's disease (PD), epilepsy, schizophrenia, and depression. In the brains of patients with AD, nAChR mRNAs are decreased in brain regions that are important for memory and cognition and significant correlations between the levels of the loss of nAChRs in the brain and the degree of cognitive decline in AD have been reported. In the brains of patients with schizophrenia, decreases in the expression of nAChRs have also been observed. Imaging studies have also revealed that nAChR availability in depressed patients across all brain regions that were evaluated was lower than that in healthy controls ( Terry et al., 2023 ).

Gangliosides have been reported to interact with neurotrophin receptors and support neuroprotective phenomena as well as other many essential functions ( Fantini and Barrantes, 2009 ; Ledeen and Wu, 2015 ; Furukawa et al., 2019 ) that are important to cholinergic neurons. For example, cholinergic innervations of the rat cortex were decorticated and intracerebroventricular infusions of GM1 showed successful attenuation of reduced choline acetyltransferase levels. This GM1 effect was similar to that of NGF infusion, while a combination infusion of NGF and GM1 had a synergistic effect to significantly increase cholinergic presynaptic terminal size ( Garofalo et al., 1993 ). In non-human primates, administration of NGF alone or in combination with GM1 induced a long-term protective effect on nucleus basalis cholinergic neurons after neocortical infarction. Although a protection of the cholinergic cell bodies was found with both treatments, a significant recovery of the neuritic processes was observed only in the double-treated monkeys ( Liberini et al., 1993 ). A potential mechanism for the positive effects of GM1 described above may be related to its binding to the high affinity NGF receptor, TrkA ( Mutoh et al., 1995 , 1998 ). The studies described here indicate that modulation of important components of the molecular environments of cholinergic neurons (via gangliosides) may have broad therapeutic potential.

2.3 Altered ganglioside composition in chemical agent exposure and in CNS diseases

Patients with ganglioside-synthase mutations have symptomatic epilepsy syndrome with severe neuronal dysfunction or hereditary spastic paraplegias with additional neurological symptoms (reviewed, Itokazu et al., 2023 ). A majority of patients with neurodegenerative diseases have alterations in their glycosphingolipid metabolism and, those changes may contribute to their accompanying pathogenesis. Concentrations of complex gangliosides such as GM1 are significantly lower in the brains of patients with AD and PD ( Wu et al., 2012 ; Hadaczek et al., 2015 ; Ariga, 2017 ; Seyfried et al., 2018 ). Some glycosphingolipid-synthase-knockouts (KO) are embryonic lethal. GM2 synthase ( GM2S ) is one of the key enzymes needed for synthesis of the major brain-type gangliosides, including GM1. GM2S-KO mice exhibit impaired movement and have virtually all the neuropathological symptoms of PD and cognitive impairment ( Wu et al., 2011 , 2012 , 2020 ). GD3 synthase (GD3S)-KO mice led to depression-like behaviors and memory defect ( Wang et al., 2014 ; Tang et al., 2021 ). With regard to the cholinergic system, Chol-1α gangliosides (GT1aα and GQ1bα, see Figure 1A ) are minor species in the brain and serve as unique markers of cholinergic neurons ( Ando et al., 1992 ; Hirabayashi et al., 1992 ; Itokazu and Yu, 2023 ). Chol-1α gangliosides may support cognitive functions such as memory and learning, and the administration of Chol-1α gangliosides appeared to alleviate the decreased synaptic functions in aged brains ( Ando, 2014 ). GT1aα and GQ1ba, were found to be elevated in the brains of the patients with AD and AD model mice ( Ariga et al., 2013 ; Ariga, 2017 ; Fukami et al., 2017 ). Neural stem cells (NSCs), non-differentiated precursor cells defined by their capacity for self-renewal and mulitpotency, express Chol-1α gangliosides ( Ngamukote et al., 2007 ). Chol-1α antigens may play an important role in cholinergic synaptic transmission and participate in cognitive function, although the detailed mechanisms need to be determined. Overall, ganglioside deficiency leads to development of neurodegenerative diseases and mental health disorders, and a proper ganglioside composition may rescue the disease phenotypes.

Figure 1 . Metabolic pathways and functional roles of glycosphingolipids, including gangliosides. (A) Metabolic pathways and structure. Cer ceramide, CST cerebroside sulfotransferase ( Gal3st1 , sulfatide synthase), GalNAc-T N-acetylgalactosaminyltransferase I ( B4galnt1 , GA2/GM2/GD2/GT2 synthase), GalT-I galactosyltransferase I ( B4galT5 & B4galt6 , lactosylceramide synthase), GalT-II galactosyltransferase II ( B3galt4 , GA1/GM1/GD1b/GT1c synthase), GalT-III galactosyltransferase III ( Ugt8a , galactosylceramide synthase), GlcT glucosyltransferase ( Ugcg , glucosylceramide synthase), ST-I sialyltransferase I ( St3gal5 , GM3 synthase), ST-II sialyltransferase II ( St8Sia1 , GD3 synthase), ST-III sialyltransferase III ( St8Sia3 , GT3 synthase), ST-IV sialyltransferase IV ( St3gal2 , GM1b/GD1a/GT1b/GQ1c synthase), ST-V sialyltransferase V ( St8sia5 , GD1c/GT1a/GQ1b/GP1c synthase), ST-VII sialyltransferase VII (St6galnac6, GD1aα/GT1aα/GQ1bα/GP1cα-synthase). Official symbols of genes are represented in italics in this figure legend. GD3 is the most abundant ganglioside in neural stem cells (NSCs). c-Series gangliosides are A2B5 antigens. GM1, GD1a, GD1b, and GT1b are the most abundant ganglioside species in adult mammalian brain and neurons. Oligodendrocyte markers O1 and O4 are GalCer and sulfatide, respectively. GT1aα and GQ1bα are cholinergic-specific antigens (Chol-1α). (B) Examples of ganglioside functions. Without GD3, Drp1 levels are increased, and aberrant mitochondrial fragmentation is augmented. GD3 suppresses p21 expression and maintains p27 expression in NSCs. Gangliosides bind to the neurotrophic factor receptors to regulate their signalings. GM1 promotes integrin signaling for cell protrusion and migration. Gangliosides prevent and even reduce the accumulation of toxic proteins [e.g., amyloid-beta peptides (Aβs) and alpha-synuclein (α-syn)] in neurodegenerative diseases. Nuclear GM1 epigenetically promotes neuronal gene expression to sustain healthy neuronal functions. Elevation of GM1 levels induces Ca influx and neurite outgrowth. The listed in the figure is a limited examples, but, ganglioside-based multifunctional therapy is promising.

Effects of organophosphates on glycolipid compositions have been reported. Subcutaneously injected organophosphate, diisopropylphosphorofluoridate (DFP) into chickens, resulted in an increase in GQ1b and GT1b levels but the proportion of GD3 decreased, while the concentrations of protein, total lipid, total cholesterol, and phospholipid were not affected ( Bush et al., 1995 ). These progressive changes in ganglioside composition correlated with increasing ataxia. Intraperitoneal administration of the organophosphate, metasystox depleted levels of gangliosides in cerebral hemisphere, cerebellum, brain stem and spinal cord of rats ( Islam et al., 1983 ). Other studies also reported that organophosphate effects on glycolipid expression in the CNS of mammals and birds ( Rozengart and Taranova, 1969 ; Taranova, 1978 ; Khan and Hasan, 1988 ). As the organophosphate-induced alteration of ganglioside composition may impact brain dysfunction, the mechanisms of ganglioside changes after the administration of organophosphate need to be determined.

2.4 Curative gangliosides are expected to protect from CNS damages against chemical threat

An often overlooked but key aspect for successful translational studies is that functional activities of proteins and genes are highly dependent upon their molecular environments. Cells and their subcellular organelles are surrounded by biological lipid membranes that define their individual cellular shape and maintain cellular organization as well as provide functional platforms for cellular signaling (reviewed, Itokazu and Yu, 2023 ). Specific gangliosides control molecular functions on biological membranes, including the plasma, mitochondrial, and nuclear membranes. For example, GD3 is involved in the maintenance of NSC fate determination by interacting with epidermal growth factor receptors (EGFRs), by modulating expression of cyclin-dependent kinase (CDK) inhibitors p27 and p21, and by regulating mitochondrial dynamics via associating a mitochondrial fission protein, the dynamin-related protein-1 (Drp1) ( Wang and Yu, 2013 ; Tang et al., 2021 ; Fuchigami et al., 2023 , 2024 ). The postnatal NSC pools are declined in GD3S-KO mice, resulting in depressive symptoms, olfactory dysfunction, and impaired memory, with the deficiency of postnatal neurogenesis ( Wang and Yu, 2013 ; Itokazu et al., 2018 ; Tang et al., 2021 ; Fuchigami et al., 2024 ). On the other hand, intranasal or intracerebroventricular infusion of GD3 restored postnatal NSC pools of GD3S-KO and AD mice ( Itokazu et al., 2019 ; Fuchigami et al., 2023 ). A major ganglioside, GM1 promotes neuronal differentiation by an epigenetic regulatory mechanism ( Tsai and Yu, 2014 ; Itokazu et al., 2016 ; Tsai et al., 2016 ). Nuclear GM1 binds with acetylated histones on the promoters of GM2S , a critical enzyme for GM1 synthesis, as well as on the NeuroD1 genes in differentiating neurons. Further, intranasal GM1 infusion increased nuclear expression of nuclear receptor-related 1 (Nurr1), an essential transcription factor for differentiation, maturation, and maintenance of midbrain dopaminergic neurons in A53T and GM2S-KO mice ( Itokazu et al., 2021 ). GM1 induces epigenetic activation of the tyrosine hydroxylase ( TH ) gene, including augmentation of acetylated histones and recruitment of Nurrr1 to the TH promoter region. To attenuate the effects of neurotoxic proteins in PD model mice, in our exciting data, nasal administration of gangliosides GM1 and/or GD3 reduced the neurotoxic α-synuclein levels and restored mitochondrial functions ( Itokazu et al., 2021 , 2023 ). Furthermore, exogenous GM1 seems beneficial to attenuate chronic microglia activation and neuroinflammation in neurodegenerative diseases ( Galleguillos et al., 2022 ). GM1 also facilitates internalization of toxic proteins, such as α-synuclein into microglia through GM1-mediated endocytosis ( Park et al., 2009 ). Pretreatment with intracerebroventricular infusion of GM1 for 4 days reduced organophosphate-, soman-induced seizure-related brain damage, while intraperitoneal injection of GM1 failed to provide protection ( Ballough et al., 1998 ). So far, intracerebroventricular administration is the most reliable method to deliver gangliosides into the brain, we developed a more convenient non-invasive delivery procedure by intranasal infusion of gangliosides with success ( Itokazu et al., 2021 ; Fuchigami et al., 2023 ). Intranasal administration can be a suitable route for efficient and non-invasive means for delivery of gangliosides to the brain, reducing systemic exposure and potential undesirable side effects.

3 Conclusion

The rapid rise in elderly populations worldwide is resulting in a dramatic increase in the incidence of age-related neurodegenerative illnesses. Currently, we lack both an understanding of the causes of these illnesses as well as how to effectively treat them. There is increasing interest in how environmental exposures over the lifespan might contribute to these diseases as well as the development of effective therapeutic interventions that are truly disease modifying and not just designed to provide temporary symptomatic relief. The purpose of this review was thus (1) to introduce one major environmental factor, toxicant (more specifically organophosphate) exposure and how it may lead to neurodegenerative illnesses, and (2) to introduce the role of gangliosides in the etiology of neurodegenerative diseases, how they may interact with organophosphates, and how exogenously administered gangliosides (especially by the intranasal route) might have diseases modifying capabilities for people who have neurodegenerative illnesses resulting from organophosphate exposures as well as other toxic insults. Gangliosides undergo dynamic qualitative and quantitative developmental, age-related, and pathological changes that correlate with neuronal function. Ganglioside microdomains provide a functional platform for cellular signaling of interacting molecules ( Figure 1B ). Progressive imbalance of cell membrane lipid composition is a physicochemical property that changes during normal aging, but further disruptions are observed in neurodegenerative diseases. A key aspect for successful translational studies is that the functional activities of proteins and genes are highly dependent upon their molecular environments, such as glycolipid micodomains. Multifunctional gangliosides can modulate protein and gene activities on plasma, mitochondrial, and nuclear membranes, in theory, may restore functions of specific molecules in the brains of patients with chemical-induced neurodegenerative diseases and mental health disorders.

Author contributions

YI: Conceptualization, Funding acquisition, Investigation, Resources, Writing—original draft, Writing—review & editing. AT: Conceptualization, Investigation, Project administration, Resources, Supervision, Writing—review & editing.

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was partly supported by a National Institute of Neurological Disorders and Stroke grant (YI: R01NS100839), a Sheffield Memorial Grant of the CSRA Parkinson's Disease Support Group (YI), and the excellent infrastructural support of the Department of Pharmacology and Toxicology, Medical College of Georgia at Augusta University.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: chemical warfare, cholinergic system, ganglioside, mental health disorder, neurodegenerative disease, neurotoxicity, organophosphate, pesticide

Citation: Itokazu Y and Terry AV Jr (2024) Potential roles of gangliosides in chemical-induced neurodegenerative diseases and mental health disorders. Front. Neurosci. 18:1391413. doi: 10.3389/fnins.2024.1391413

Received: 25 February 2024; Accepted: 12 April 2024; Published: 22 April 2024.

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*Correspondence: Yutaka Itokazu, yitokazu@augusta.edu ; Alvin V. Terry Jr., aterry@augusta.edu

† ORCID: Yutaka Itokazu orcid.org/0000-0001-7800-8262 Alvin V. Terry Jr. orcid.org/0000-0003-2071-4767

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.