Mental Health and Mental Illness

Mental health and mental illness can be thought of as two ends of a spectrum. Mental health is a state of emotional and social wellbeing in which an individual realises his or her own abilities, copes with the normal stresses of life, works productively or fruitfully, and makes a contribution to his or her community. Being mentally healthy enables individuals to live rich, full, and meaningful lives. Conversely, mental illness is generally considered to be present when an individual is emotionally and socially disturbed to the extent that they are unable to realise their own potential, cope with the normal stress of life, work productively or fruitfully, nor make a meaningful contribution to their community.

The Importance of Diagnosis

Depending upon the specific characteristics of an individual’s difficulties and the constellation of associated biological, psychological, and social symptoms, a diagnosis of a particular mental disorder may be made by a suitably qualified health professional. A mental disorder is a diagnosable illness that significantly interferes with an individual’s cognitive, emotional, social, and occupational abilities and this is a change from their normal baseline.

It is important to recognise the difference between experiencing life stress, which is generally less impactful, and is transient and self-resolving, and having a diagnosable mental illness, which can often be long-standing, has a considerable impact on the individual, and often will not self-resolve without provision of appropriate intervention. For all mental disorders, the presence of symptoms does not necessitate a diagnosis unless symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Moreover, symptoms must occur frequently and for a significant period of time.

Although diagnosis of a mental disorder can often be viewed as stigmatising for an individual, it can also be validating for an individual to be informed that what they are experiencing is a serious illness and diagnosis can also empower them to seek appropriate treatment. Diagnosis is also important for streamlining communication between mental health professionals about clients and between clients and their treatment team. Finally, diagnosis allows for evidence-based selection of available treatments that have been specifically designed and scientifically evaluated to effectively address particular disorders.

Causes of Mental Illness

There is ongoing debate amongst the mental health field about the true cause of mental illness. A considerable proportion of this debate stems from the distinct perspectives of different types mental health professionals. For example, medical professionals are often biased towards seeking biological causes whilst psychologists are often biased towards seeking psychological understandings and social workers are often biased towards seeking social explanations. Our best understanding is that mental illness is caused by a combination of biological, psychological, and social factors, with no one type of factor alone yet demonstrated to be the sole cause of mental illness. Some disorders are more strongly associated with underlying biological vulnerabilities, whilst others have more prominent social and psychological causes. For example Schizophrenia is one of the most heritable disorders, suggesting a strong biological component. In contrast, Post-Traumatic Stress Disorder requires the experience and psychological evaluation of a traumatic event, suggesting a strong psychological component. Social factors appear to be best understood as an important contributor to the development of mental illness, rather than directly causing mental disorders. Moreover, individual differences are important: distinct individuals are more or less likely than other similar individuals to respond to their environment with the eventual development of mental illness.

Complicating the picture further is that each of biological, psychological, and social factors can be viewed as the predisposing, precipitating, and the perpetuating factor for different individuals or for different illnesses. For example, an individual may have an underlying biological vulnerability that an environmental stressor triggers in the form of expression of a mental illness. In contrast, the experience of a traumatic event can trigger psychological, social, and biological changes and the development of a mental illness in an individual not predisposed to mental illness. Such complexity demands a nuanced understanding of each individual’s experience in order to determine an accurate diagnosis (where appropriate) and consequent provision of the most appropriate and effective treatment available.

Why Focus on Mental Health?

The annual cost of mental illness in Australia has been estimated at $20 billion, which includes the cost of lost productivity and labour force participation. In 2003, mental disorders were identified as the leading cause of healthy years of life lost due to disability. In 2007, 45% of Australians aged 16-85 years, (or 7.3 million people), had at some point in their lifetime experienced a diagnosable mental disorder. Some of the most prominent mental disorders include Anxiety Disorders, Depressive Disorders, and Substance-Related and Addictive Disorders.

Anxiety Disorders

In 2007, Anxiety Disorders were the most common class of mental disorder in Australia, affecting 14% of all people aged 16-85 years in the prior 12 months. Women were more likely to have experienced Anxiety Disorders than men, 18% to 11%. The core characteristics of Anxiety Disorders are (1) excessive anxiety and worry (apprehensive expectation); (2) difficulties controlling the worry; and (3) presence of a number of associated symptoms including restlessness, irritability, muscle tension, fatigue, and sleep disturbance. Depending upon the particular constellation of symptoms, a specific anxiety disorder may be diagnosed. Some of the more prevalent anxiety disorders include Generalised Anxiety Disorder, Panic Disorder, and Social Anxiety Disorder.

Depressive Disorders

In 2007, Depressive Disorders and Bipolar and Related Disorders (previously collectively considered Mood Disorders) affected 6.2% of Australians aged 16-85 years in the prior 12 months. Women experienced more Mood Disorders than men, 7.1% to 5.3%. The majority of diagnosed Mood Disorders were Depressive Disorders. The core characteristics of Depressive Disorders include (1) depressed mood; (2) loss of interest or pleasure in normally enjoyable activities; (3) significant change in weight /appetite; (4) sleep disturbance; (5) physical agitation or retardation; (6) fatigue or lethargy; (7) feelings of worthlessness; (8) difficulties concentrating; and (9) recurrent thoughts of death. The main types of Depressive Disorders are Major Depressive Disorder and Persistent Depressive Disorder.

Substance-Related and Addictive Disorders

In 2007 in Australia 5.1% of people aged 16-85 years had a Substance-Related and Addictive Disorder in the prior 12 months. Substance-Related and Addictive Disorders were more common in men than in women. The core characteristics of Substance-Related and Addictive Disorders include (1) using a substance in larger amounts and for longer than intended; (2) wanting to cut down or quit but not being able to; (3) spending a lot of time obtaining the substance; (4) craving; (5) failing to carry out major occupational and social obligations; (6) use despite social or interpersonal problems; (7) reducing social, occupational, or recreational activities; (8) use in physically hazardous situations; (9) use despite physical or psychological difficulties; (10) tolerance; and (11) withdrawal. The specific type of Substance-Related and Addictive Disorder depends upon the substance being used.

Treatment

Thankfully there are a range of evidence-based and effective treatments for the aforementioned prevalent mental disorders in addition to many of the other mental illnesses not specified above. The core schools of treatment generally stem from the psychological and the biological understandings of mental illness. Psychotherapy has been utilised in differing forms for over a century and there now exists a plethora of available psychotherapeutic interventions that are of varying effectiveness for different conditions. Some of the main psychotherapeutic schools include Psychoanalytic Therapeutic approaches including its more contemporary form Psychodynamic Therapy and Cognitive Behavioural Therapeutic approaches including Cognitive Therapy, Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Therapy, and Dialectical Behaviour Therapy. These approaches focus on the unconscious (Psychoanalytic) or conscious (Cognitive Behavioural) mind and the impact on the individual’s self and behaviour. In contrast, Behavioural approaches focus purely on behaviour of an individual and utilise the principles of reinforcement to shape future behaviour. Finally, pharmacological approaches view the development mental illness as stemming from an imbalance in neurotransmitters in the brain (e.g., serotonin in Depressive Disorders and dopamine in Psychotic Disorders). As a consequence these approaches treat individuals with medications that are purported to re-balance these neurotransmitters (e.g., anti-depressants and anti-psychotics). For different disorders that present distinctly and have varying aetiologies there needs to be appropriate treatment selection. Best practice may be the provision of medication or psychotherapy alone or in combination.

How to Get Help

The first step in addressing a mental health issue is the development of awareness such that a problem is identified and acknowledged as an issue that needs to be addressed. The second step is seeking treatment. The mental health system in Australia is complex and convoluted, which can be a considerable deterrent to help-seeking behaviour. If you believe you are being impacted by a mental health issue and want to seek treatment, the best first point of contact is your local General Practitioner (GP) or community health service. Your GP or community health service is able to make an initial assessment to determine if formal treatment is required and refer you to a mental health professional (where appropriate). To assist in understanding the different types of mental health professionals and roles they may play in your treatment, please see the tables below.

Medicare Endorsed Mental Health Professionals

Role in Mental Health Treatment

Individual Dimensions Addressed

General PractitionerDiagnosis; front-line assessment; basic treatment; referral to other mental health professionalsBiological; physical health
PsychologistDiagnosis; psychological assessment; psychotherapeutic interventionPsychological; behavioural; social; mental health
Occupational TherapistFunctional assessment; functional intervention; assessment and modification of occupational environmentOccupational; functional
Mental Health NurseMental health assessment; mental health monitoring; behavioural support and monitoringMental health; behavioural
PsychiatristDiagnosis; psychiatric assessment; pharmacological treatmentBiological; mental health
Accredited Mental Health Social WorkerMental health assessment; case management; referral to support servicesSocial; mental health; relational
Note: Accredited Mental Health Social Workers are registered with Medicare and registered by the Australian Association of Social Workers; all other listed health professionals are registered and regulated by the Australian Health Practitioners Regulation Agency (AHPRA).

Non-Medicare Endorsed Mental Health Professionals

Role in Mental Health Treatment

Individual Dimensions Addressed

CounsellorCounsellingMental health; life goals and values
Psychotherapistpsychotherapeutic interventionMental health; life goals and values
Life CoachMotivational interventionLife goals and values
Spiritual LeaderSpiritual guidanceSpiritual

Why Regulation Is Important

The above tables highlight one important distinction amongst mental health professionals that is often overlooked, misunderstood, and hence is pertinent to highlight. This distinction is registration with and regulation by AHPRA. Registration with AHPRA is aimed at protecting the community and regulating health professionals to ensure that professionals are appropriately trained and provide the highest quality service. Registration and Accreditation with alternate Professional Bodies (e.g., Australian Association of Social Workers and Psychotherapy and Counselling Federation of Australia) goes some way to ensuring standards of practice amongst mental health professionals not registered with AHPRA, but these Professional Bodies cannot prevent a mental health professional from practicing.

In each of the professions regulated by AHPRA if a professional is considered to have breached ethical and professional standards or otherwise engaged in serious misconduct they can be reported to AHPRA. AHPRA can consequently de-register these professionals disabling them from practicing under their respective titles (e.g., Psychologist, General Practitioner, Psychiatrist etc.).

In contrast, the mental health professionals not registered with AHPRA cannot be regulated by AHPRA and hence there services are not quality controlled to the same extent. Each of these professionals may have received considerable training and provide an exceptional quality of service. However, none of the aforementioned professionals are registered by AHPRA and hence professional regulation and consequently consumer protection against poor quality services cannot be guaranteed. For example, any individual can practice as a Life Coach, regardless of training, and even if a Counsellor engages in misconduct they can continue to practice as a Counsellor.

 

References

American Psychiatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Association.

Australian Bureau of Statistics (2010). 1301.0 – Year Book Australia, 2009–10. Retrieved from http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/1301.0main%20features12009-10

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Kaine Grigg

Dr Kaine Grigg is co-founder of, and consultant clinical psychologist for, FreoMind. He is also the Principal Consultant Psychologist for the Australian Clinical and Forensic Psychology Services, a Consultant Clinical Psychologist with Suicide Risk Assessment Australia and a clinical psychologist within the WA Departments of Justice and Health. Kaine has a wealth of clinical knowledge and experience from working with children and adolescents, individuals impacted by substance use/dependence, trauma and those with offending histories. Kaine will be contributing a regular column to Freo Pages on behalf of Freo Mind. Articles will address all topics related to mental health, resilience and social and emotional wellbeing relevant to the Fremantle community.